Outpatient Management of Imported Non-Severe Falciparum Malaria in Adults in the United Kingdom: a Multi-Site Evaluation of Clinical Safety and Costing Analysis
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ID: 321903
2026
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Abstract
Abstract Background Imported falciparum malaria represents a significant healthcare burden disproportionate to its incidence. UK guidelines traditionally recommended admission for all cases of non-severe falciparum malaria. However, it is recognised that cases of non-severe malaria meeting appropriate clinical criteria do not require additional supportive treatment and can be managed safely as outpatients. Routine inpatient management may increase reluctance to present to hospital early and increase healthcare system and patient costs. Methods We conducted a prospective multi-site cohort study across five UK centres from 2019-2024, evaluating outpatient management of adults with non-severe falciparum malaria. 121 patients received outpatient treatment with artemether-lumefantrine (AL) for three days, with structured follow-up including clinical review and/or repeat malaria testing. A micro-costed sub-analysis of two sites compared the cost of care of outpatient treatment to a control group, defined as non-severe malaria cases who were clinically similar but admitted overnight. Results Clinical or parasitological cure within 2 weeks of initial blood film was achieved in 91% (99/109) of patients receiving outpatient artemether-lumefantrine therapy with appropriate follow-up. No escalations to high-dependency or intensive care, and no deaths occurred during the study period. Amongst those requiring further intervention, 50% (5/10) did not complete the initial course. Costing analysis of outpatients versus patients admitted for non-clinical reasons demonstrated significant savings, with median costs of £1248 and £1792 respectively. Conclusions Outpatient management of carefully-selected patients with non-severe falciparum malaria appears clinically safe and economically justified. These findings support development of standardised outpatient protocols for non-severe falciparum malaria, potentially reducing healthcare costs while maintaining patient safety.
| Reference Key |
openalex_W7170090371
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| Authors | James Milburn, Anne Williamson, S Baljekar, R Rachman, Anna Daunt, Naomi Richardson, F Olcott, C Rodrigues, R Thangarajah, S Yeung, M Arias, C Jennings, A Delmonte Sen, J L Klein, A Odedra, N Jacobs, C Drapeau, C van Halsema, G O’Hara, A Checkley |
| Journal | Open forum infectious diseases |
| Year | 2026 |
| DOI |
10.1093/ofid/ofag443
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| URL | |
| Keywords | Keywords not found |
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