Background: Although approximately 1000 U.S. citizens per year are reported to the Centers for Disease Control and Prevention as having acquired malaria infection during foreign travel, little information exists with regard to the cost and appropriateness of malaria therapy received in the United States.
Methods: Data on treatment of U.S. citizens reported to the Centers for Disease Control and Prevention (CDC) as having acquired Plasmodium falciparum malaria in 1988–1989 while traveling in subSaharan Africa were collected by phone interview. These data were used to derive a relative index of illness severity, to estimate the costs of malaria-specific therapy, and to assess adherence to existing therapy recommendations. All monetary values throughout this study will be expressed in U.S. dollars.
Results: Of 142 patients, 110 (77%) were classified as having mild, 21 (15%) as having moderate, and 11 (8%) as having severe infections. Two (1.4%) deaths were reported. Overall, the mean (± standard deviation) cost of treatment per case was $2743.51 (± 8416.82; range $191.75 to $79,801.73). Estimated with relation to severity, the median cost for treatment per case was $467.54 for mild, $2701.16 for moderate, and $12,515.52 for severe infections. Forty-two (30%) of these patients had at least one element of therapy that was inconsistent with recommendations current at the time of the study; 27(19%) received chloroquine; 12 (9%) received primaquine unnecessarily; eight (6%) received inappropriate dosages of pyrimethamine/sulfadoxine (Fansidar)*; and three (2%) received potentially inappropriate dosing regimens of quinine.
Conclusions: The relatively low fatality rate, and the fact that 70% of patients received appropriate therapy suggests that the overall standard of care for what is a relatively infrequent disease in the United States is good. However, because of rapidly changing drug resistance patterns, both physicians and travelers need to remain informed to avoid the costs and risks of this potentially severe, but easily preventable infectious disease.