Cost effectiveness analysis of strategies to combat malaria in developing countries

Abstract

Objective To determine the cost effectiveness of selected malaria control interventions in the context of reaching the millennium development goals for malaria. Design Generalised cost effectiveness analysis. Data sources Efficacy data came from the literature and authors' calculations supported by expert opinion. Quantities for resource inputs came from the literature and from expert opinion; prices came from the WHO-CHOICE database. Methods Costs were assessed in year 2000 international dollars, and effects were assessed as disability adjusted life years averted by a 10 year implementation programme. Analysis was restricted to sub-Saharan regions where the most deadly form of malaria, Plasmodium falciparum, is most prevalent. The impact on population health for various interventions, and their combinations, was evaluated at selected coverage levels by using a state-transition model. Sensitivity analysis was done for age weights and discounting. Results High coverage with artemisinin based combination treatments was found to be the most cost effective strategy for control of malaria in most countries in sub-Saharan Africa. Conclusions A much larger infusion of resources than those currently available is needed to make headway in the fight to roll back malaria. On cost effectiveness grounds, in most areas in sub-Saharan Africa greater coverage with highly effective combination treatments should be the cornerstone of malaria control. However, treatment alone can achieve less than half the total benefit obtainable through a combination of interventions-scaling up the use of impregnated mosquito nets or indoor spraying with insecticides is also critical. Intermittent presumptive treatment of pregnant women can bring a small but important additional health gain at relatively low cost.

Implications for health education and intervention strategies arising from children's caregivers concerns following successful malaria control

“…The dialectic regarding ITNs and IRS in southern Africa has recently been summarised by Cliff et al 22 as these two methods are currently the principal strategies recommended for vector management. 23 Both seemed equally effective, costs were similar 24 and each one has a place in integrated malaria vector management.…”

Cost–effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea

“…8 In studies from two sub-Saharan regions, high ACT coverage was found to be the most cost-effective strategy for malaria control (9-12 international dollars per disability-adjusted life year averted) compared with insecticide-treated bed nets, indoor residual spraying and intermittent preventive treatment in pregnancy. 22 Some population data from Papua New Guinea are detailed enough to estimate the benefits of ACT regimens. In 2004, 1 660 645 malaria patients (28.7% of the total population, assuming no double counting) were treated in Papua New Guinea.…”

Impact of health facilities on malaria control interventions among children under five years of age and pregnant women in Nigeria

“…1 Evidence on the cost-effectiveness of malaria control interventions such as ITNs, IRS, IPTp and RDTs in subSaharan Africa, Asia and South America show different variation in their outcomes with the median cost of administering IPTp to pregnant women substantially less expensive while RDT diagnosis was found to be cost-effective. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] There is no study conducted to the best of our knowledge on the impact of health facilities on malaria control interventions among the most at risk group using a nationally representative household survey in order to inform policy decisions and aid strategies that will specifically address the burden of malaria among under five children and pregnant women.…”