Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review

Conteh, Lesong; Shuford, Kathryn; Agboraw, Efundem; Kont, Mara D.; Kolaczinski, Jan; Patouillard, Edith

doi:10.1016/j.jval.2021.01.013

Cited by 43 publications

(42 citation statements)

References 106 publications

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“…A systematic review published in 2011 found that the median incremental cost-effectiveness ratio per DALY averted ranged from 8.15 to 150.00 USD (~ 10.00 to 200.00 USD in 2020 value) for intermittent preventive treatment in pregnancy, ITNs, and IRS [ 7 ]. A similar review published in 2021 found a similar range in literature from 2005 to 2018 [ 8 ]. These systematic reviews generally covered studies where the comparator was no intervention; thus the ICER in the studies reviewed would be expected to be lower than when adding the intervention on to the other standard interventions, as was the case in this study since the ICER estimated in this study is effectively marginal rather than generalized.…”

Section: Discussionmentioning

confidence: 59%

“…However, the review identified no cost or cost-effectiveness studies published after the year 2001, and thus did not include the more recent expansion of IRS geographies and products in sub-Saharan Africa. A more recent systematic review covering literature from 2005 to 2018 found no new cost-effectiveness studies of IRS published in this period [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incremental cost and cost-effectiveness of the addition of indoor residual spraying with pirimiphos-methyl in sub-Saharan Africa versus standard malaria control: results of data collection and analysis in the Next Generation Indoor Residual Sprays (NgenIRS) project, an economic-evaluation

Yukich¹,

Digre

Scates³

et al. 2022

Malar J

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Background Malaria is a major cause of morbidity and mortality globally, especially in sub-Saharan Africa. Widespread resistance to pyrethroids threatens the gains achieved by vector control. To counter resistance to pyrethroids, third-generation indoor residual spraying (3GIRS) products have been developed. This study details the results of a multi-country cost and cost-effectiveness analysis of indoor residual spraying (IRS) programmes using Actellic®300CS, a 3GIRS product with pirimiphos-methyl, in sub-Saharan Africa in 2017 added to standard malaria control interventions including insecticide-treated bed nets versus standard malaria control interventions alone. Methods An economic evaluation of 3GIRS using Actellic®300CS in a broad range of sub-Saharan African settings was conducted using a variety of primary data collection and evidence synthesis methods. Four IRS programmes in Ghana, Mali, Uganda, and Zambia were included in the effectiveness analysis. Cost data come from six IRS programmes: one in each of the four countries where effect was measured plus Mozambique and a separate programme conducted by AngloGold Ashanti Malaria Control in Ghana. Financial and economic costs were quantified and valued. The main indicator for the cost was cost per person targeted. Country-specific case incidence rate ratios (IRRs), estimated by comparing IRS study districts to adjacent non-IRS study districts or facilities, were used to calculate cases averted in each study area. A deterministic analysis and sensitivity analysis were conducted in each of the four countries for which effectiveness evaluations were available. Probabilistic sensitivity analysis was used to generate plausibility bounds around the incremental cost-effectiveness ratio estimates for adding IRS to other standard interventions in each study setting as well as jointly utilizing data on effect and cost across all settings. Results Overall, IRRs from each country indicated that adding IRS with Actellic®300CS to the local standard intervention package was protective compared to the standard intervention package alone (IRR 0.67, [95% CI 0.50–0.91]). Results indicate that Actellic®300CS is expected to be a cost-effective (> 60% probability of being cost-effective in all settings) or highly cost-effective intervention across a range of transmission settings in sub-Saharan Africa. Discussion Variations in the incremental costs and cost-effectiveness likely result from several sources including: variation in the sprayed wall surfaces and house size relative to household population, the underlying malaria burden in the communities sprayed, the effectiveness of 3GIRS in different settings, and insecticide price. Programmes should be aware that current recommendations to rotate can mean variation and uncertainty in budgets; programmes should consider this in their insecticide-resistance management strategies. Conclusions The optimal combination of 3GIRS delivery with other malaria control interventions will be highly context specific. 3GIRS using Actellic®300CS is expected to deliver acceptable value for money in a broad range of sub-Saharan African malaria transmission settings.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Incremental cost and cost-effectiveness of the addition of indoor residual spraying with pirimiphos-methyl in sub-Saharan Africa versus standard malaria control: results of data collection and analysis in the Next Generation Indoor Residual Sprays (NgenIRS) project, an economic-evaluation

Yukich¹,

Digre

Scates³

et al. 2022

Malar J

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“…Our analysis also suggests PDMC will be highly cost-effective across a wide range of settings, given that the cost of inpatient malaria care in sub-Saharan Africa is $15.64-$137.87. 29 However, cost-effectiveness will depend on the local costs of clinical management and the organisation of health care services.…”

Section: Discussionmentioning

confidence: 99%

Projected health impact of post-discharge malaria chemoprevention among children with severe malarial anaemia in Africa

Okell

Kwambai

Dhabangi

et al. 2022

Preprint

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Background Children discharged from hospital after recovery from severe malarial anaemia (SMA) are at high risk of readmission and death in subsequent months. Clinical trial results show that three months of post-discharge malaria chemoprevention (PMC) with dihydroartemisinin-piperaquine reduces this risk. Methods We developed a compartmental mathematical model describing the daily post-discharge incidence of uncomplicated and severe malaria requiring readmission among a cohort of 0-5 year-old children. We fitted the model to PMC and placebo groups from nine trial hospitals in areas of moderate-to-intense malaria transmission in Uganda and Kenya using Bayesian methods. The cohort model was then embedded within a full population model of SMA to predict impact of PMC across malaria-endemic African countries. Results The incidence of hospitalised malaria episodes during the first 6 months post-discharge is estimated to be ~23-60 times higher than the average for children of this age, depending on transmission intensity. We estimate that repeat SMA episodes within 6 months of the original episode constitute 18-27% of all SMA episodes in high transmission settings. In the 20 highest-burden countries in Africa, only 2-5 children need to be given PMC to prevent one hospitalised malaria episode, and less than 100 to prevent one death. If all hospitalised cases access PMC, we estimate that 36,000 (range 16,000-82,000) malaria-associated readmissions could be prevented annually, depending on the proportion accessing hospital care. Interpretation PMC has high potential impact per child treated across a range of epidemiological settings in Africa.

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“…Regardless of public or private provider, the averted cost reflects the total averted healthcare expenditure on treating malaria including out-of-pocket spending. The treatment cost measures were specified as the median provider economic cost of treating an episode of malaria from the systematic review by Conteh, et al , 23 which reported the treatment cost of an uncomplicated episode as US$9.31 and that of a severe episode as US$89.93 in 2018. From 2023 to 2027, the averted treatment cost (

) due to iMDA for country

at year

given a proportion of severe episodes (

) was…”

Section: Methodsmentioning

confidence: 99%

Potential impact of 5 years of ivermectin mass drug administration on malaria outcomes in high burden countries

et al. 2021

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IntroductionThe global progress against malaria has slowed significantly since 2017. As the current malaria control tools seem insufficient to get the trend back on track, several clinical trials are investigating ivermectin mass drug administration (iMDA) as a potential additional vector control tool; however, the health impacts and cost-effectiveness of this new strategy remain unclear.MethodsWe developed an analytical tool based on a full factorial experimental design to assess the potential impact of iMDA in nine high burden sub-Saharan African countries. The simulated iMDA regimen was assumed to be delivered monthly to the targeted population for 3 months each year from 2023 to 2027. A broad set of parameters of ivermectin efficacy, uptake levels and global intervention scenarios were used to predict averted malaria cases and deaths. We then explored the potential averted treatment costs, expected implementation costs and cost-effectiveness ratios under different scenarios.ResultsIn the scenario where coverage of malaria interventions was maintained at 2018 levels, we found that iMDA in these nine countries has the potential to reverse the predicted growth of malaria burden by averting 20–50 million cases and 36 000–90 000 deaths with an assumed efficacy of 20%. If iMDA has an efficacy of 40%, we predict between 40–99 million cases and 73 000–179 000 deaths will be averted with an estimated net cost per case averted between US$2 and US$7, and net cost per death averted between US$1460 and US$4374.ConclusionThis study measures the potential of iMDA to reverse the increasing number of malaria cases for several sub-Saharan African countries. With additional efficacy information from ongoing clinical trials and country-level modifications, our analytical tool can help determine the appropriate uptake strategies of iMDA by calculating potential marginal gains and costs under different scenarios.

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Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review

Cited by 43 publications

References 106 publications

Incremental cost and cost-effectiveness of the addition of indoor residual spraying with pirimiphos-methyl in sub-Saharan Africa versus standard malaria control: results of data collection and analysis in the Next Generation Indoor Residual Sprays (NgenIRS) project, an economic-evaluation

Incremental cost and cost-effectiveness of the addition of indoor residual spraying with pirimiphos-methyl in sub-Saharan Africa versus standard malaria control: results of data collection and analysis in the Next Generation Indoor Residual Sprays (NgenIRS) project, an economic-evaluation

Projected health impact of post-discharge malaria chemoprevention among children with severe malarial anaemia in Africa

Potential impact of 5 years of ivermectin mass drug administration on malaria outcomes in high burden countries

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