Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana

Abstract

BackgroundIn Ghana, malaria is endemic and perennial (with significant seasonal variations in the three Northern Regions), accounting for 33 % of all deaths among children under 5 years old, with prevalence rates in children under-five ranging from 11 % in Greater Accra to 40 % in Northern Region. Ghana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) strategy with a trial in the Upper West Region in 2015. The objective of this study was to estimate the cost-effectiveness of seasonal malaria chemoprevention.MethodsCosts were analysed from provider and societal perspectives and are reported in 2015 US$. Data on resource use (direct and indirect costs) of the SMC intervention were collected from intervention records and a survey in all districts and at regional level. Additional numbers of malaria cases and deaths averted by the intervention were estimated based on prevalence data obtained from an SMC effectiveness study in the region. Incremental cost-effectiveness ratios (ICERs) were estimated for the districts and region. Sensitivity analyses were conducted to test the robustness of the ICERs.ResultsThe total financial cost of the intervention was US$1,142,040.80. The total economic cost was estimated to be US$7.96 million and US$2.66 million from the societal and provider perspectives, respectively. The additional numbers of cases estimated to be averted by the intervention were 24,881 and 808, respectively. The economic cost per child dosed was US$67.35 from societal perspective and US$22.53 from the provider perspective. The economic cost per additional case averted was US$107.06 from the provider perspective and US$319.96 from the societal perspective. The economic cost per additional child death averted by the intervention was US$3298.36 from the provider perspective and US$9858.02 from the societal perspective. The financial cost per the SMC intervention delivered to a child under-five was US$9.66. The ICERs were sensitive to mortality rate used.ConclusionsThe SMC intervention is economically beneficial in reducing morbidity in children under-5 years and presents a viable approach to improving under-five health in Ghana.

Multilevel modelling of malaria risk in children under five years old in Nigeria

“…shown to signi cantly reduce malaria in under 5 children participating in the mass drug administration program in different areas of diverse malaria transmission intensity (14)(15)(16)(17). Some economic bene t has further been attributed to seasonal malaria chemoprevention of all under 5 children (16,18), with recommendation for this approach to be integrated into the health system in endemic areas.…”

Seasonal malaria chemoprevention: successes and missed opportunities

“…Few data from programme-implementation settings have been published, but one recent observational study in Mali in 2014 showed that prevalence of parasitaemia at the end of the high transmission seasonal was lower in areas receiving SMC (18%) than in areas not receiving SMC (46%) [ 14 ]. For recipients, data from clinical trials suggested high levels of community acceptability when taken during the peak malaria season [ 15 ], and at least one study from a programme implementation setting has shown a reasonable cost-effectiveness of the strategy (approximately US $100 per case averted and $3300 per under-5 death averted) [ 16 ], but broader data have yet to be published.…”

Implementation, coverage and equity of large-scale door-to-door delivery of Seasonal Malaria Chemoprevention (SMC) to children under 10 in Senegal

“…A door-to-door approach was employed in this study. Experience with different modes of delivery is being gained 12 , 13 and evaluations are being undertaken through the ACCESS-SMC project 14 . Delivery through fixed points has been less effective than delivery door to door.…”