Cost-effectiveness of artemisinin-based combination therapies for first-line treatment of malaria among pediatric and adult populations: a systematic review protocol

OBJECTIVE: This systematic review will aim to evaluate the evidence on the cost-effectiveness of artemisinin-based combination therapies (ACTs) when used as a first-line treatment for malaria, providing evidence-based guidance for policymakers in resource-limited settings. INTRODUCTION: ACTs have become the World Health Organization's recommended first-line treatment for uncomplicated Plasmodium falciparum malaria due to their efficacy. Economic constraints in endemic regions necessitate the assessment of their cost-effectiveness. ELIGIBILITY CRITERIA: Studies will be eligible if they report on the cost-effectiveness or cost-utility of ACTs and non-ACT or different ACT dose regimens as first-line treatments for malaria among pediatric and adult populations. METHODOLOGY: This review will follow the JBI methodology for systematic reviews of economic evidence. PubMed was used to conduct a preliminary search using MeSH terms such as malaria, artemisinin combination therapy, non-artemisinin combination therapy, and cost-effectiveness. This initial search strategy will be adapted to other academic and non-academic databases as well as gray literature. Two reviewers will independently screen records at the title/abstract and full-text levels, with disagreements resolved by a third reviewer. Two reviewers will then conduct a methodological quality assessment and extract data in accordance with JBI guidelines. A summary and comparison of the included studies will be based on the JBI Dominance Ranking Matrix for economic evaluations. The measures of cost-effectiveness/cost-utility will consist of the incremental cost-effectiveness ratio (ICER), the ICER per disability-adjusted life year averted, or the quality-adjusted life years gained. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach will be used to appraise the certainty of economic evidence. PROSPERO REGISTRATION ID: CRD420251058688.