Outpatient Management of Imported Nonsevere Falciparum Malaria in Adults in the United Kingdom: A Multisite Evaluation of Clinical Safety and Costing Analysis.

BACKGROUND

Imported falciparum malaria represents a significant health care burden disproportionate to its incidence. UK guidelines have traditionally recommended admission for all cases of nonsevere falciparum malaria. However, it is recognized that cases of nonsevere malaria meeting appropriate clinical criteria do not require additional supportive treatment and can be managed safely outpatient. Routine inpatient management may increase reluctance to present to hospital early and increase health care system and patient costs.

METHODS

We conducted a prospective multisite cohort study across 5 UK centers from 2019 to 2024, evaluating outpatient management of adults with nonsevere falciparum malaria. One hundred twenty-one patients received outpatient treatment with artemether-lumefantrine (AL) for 3 days, with structured follow-up including clinical review and/or repeat malaria testing. A micro-costed subanalysis of 2 sites compared the cost of care of outpatient treatment with a control group, defined as nonsevere 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. Among those requiring further intervention, 50% (5/10) did not complete the initial course. A cost analysis of outpatients vs patients admitted for nonclinical reasons demonstrated significant savings, with median costs of £1248 and £1792, respectively.

CONCLUSIONS

Outpatient management of carefully selected patients with nonsevere falciparum malaria appears clinically safe and economically justified. These findings support development of standardized outpatient protocols for nonsevere falciparum malaria, potentially reducing health care costs while maintaining patient safety.