The economics of malaria control and elimination: a systematic review

Abstract

BackgroundDeclining donor funding and competing health priorities threaten the sustainability of malaria programmes. Elucidating the cost and benefits of continued investments in malaria could encourage sustained political and financial commitments. The evidence, although available, remains disparate. This paper reviews the existing literature on the economic and financial cost and return of malaria control, elimination and eradication.MethodsA review of articles that were published on or before September 2014 on the cost and benefits of malaria control and elimination was performed. Studies were classified based on their scope and were analysed according to two major categories: cost of malaria control and elimination to a health system, and cost-benefit studies. Only studies involving more than two control or elimination interventions were included. Outcomes of interest were total programmatic cost, cost per capita, and benefit-cost ratios (BCRs). All costs were converted to 2013 US$ for standardization.ResultsOf the 6425 articles identified, 54 studies were included in this review. Twenty-two were focused on elimination or eradication while 32 focused on intensive control. Forty-eight per cent of studies included in this review were published on or after 2000. Overall, the annual per capita cost of malaria control to a health system ranged from $0.11 to $39.06 (median: $2.21) while that for malaria elimination ranged from $0.18 to $27 (median: $3.00). BCRs of investing in malaria control and elimination ranged from 2.4 to over 145.ConclusionOverall, investments needed for malaria control and elimination varied greatly amongst the various countries and contexts. In most cases, the cost of elimination was greater than the cost of control. At the same time, the benefits of investing in malaria greatly outweighed the costs. While the cost of elimination in most cases was greater than the cost of control, the benefits greatly outweighed the cost. Information from this review provides guidance to national malaria programmes on the cost and benefits of malaria elimination in the absence of data. Importantly, the review highlights the need for more robust economic analyses using standard inputs and methods to strengthen the evidence needed for sustained financing for malaria elimination.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1635-5) contains supplementary material, which is available to authorized users.

Role of phospholipid synthesis in the development and differentiation of malaria parasites in the blood

“…However, despite this success, the death toll is still unacceptably high. Emerging drug resistance to first line therapies and the high cost of drugs continue to add more health and economic burden on the affected populations (1,4,5). The development of an effective vaccine continues to be both scientifically and technically challenging.…”

Diversity and Multiplicity of P. falciparum infections among asymptomatic school children in Mbita, Western Kenya

“…Overall, progress towards malaria control and elimination has stalled across all World Health Organisation (WHO) regions. The stagnancy in the global fight against the disease is partly due to decreased funding from international donors 1,[20][21][22][23] . However, the high prevalence of asymptomatic carriers especially among older children 19,[24][25][26][27][28] , high recombination rates among distinct P. falciparum clones in endemic settings leading to emergence of highly diverse parasite isolates, rapid emergence and distribution of drug resistant P. falciparum parasite strains [29][30][31][32][33] , and prevalence of infections characterized by multiple genetically distinct parasite strains are some of the major contributing factors hindering the global malaria control and elimination 31,34,35 .…”

An ingredients-based approach to costing integrated malaria elimination strategies: an example from Myanmar

“…Myanmar has set a goal to interrupt transmission and eliminate P. falciparum malaria from the entire country by 2025 [26]. Malaria elimination requires a substantial level of investment, especially for detecting and responding to small numbers of remaining malaria cases [27]. Which malaria intervention packages to use and the resources needed to eliminate this disease nationally and sub-nationally is a challenging question for a developing country that largely relies on external funding to achieve this goal.…”