Cost Effectiveness Analysis of Optimal Malaria Control Strategies in Kenya

Gabriel Otieno,John Mutiso,Joseph Koske

doi:10.3390/math4010014

Abstract

Malaria remains a leading cause of mortality and morbidity among the children under five and pregnant women in sub-Saharan Africa, but it is preventable and controllable provided current recommended interventions are properly implemented. Better utilization of malaria intervention strategies will ensure the gain for the value for money and producing health improvements in the most cost effective way. The purpose of the value for money drive is to develop a better understanding (and better articulation) of costs and results so that more informed, evidence-based choices could be made. Cost effectiveness analysis is carried out to inform decision makers on how to determine where to allocate resources for malaria interventions. This study carries out cost effective analysis of one or all possible combinations of the optimal malaria control strategies (Insecticide Treated Bednets—ITNs, Treatment, Indoor Residual Spray—IRS and Intermittent Preventive Treatment for Pregnant Women—IPTp) for the four different transmission settings in order to assess the extent to which the intervention strategies are beneficial and cost effective. For the four different transmission settings in Kenya the optimal solution for the 15 strategies and their associated effectiveness are computed. Cost-effective analysis using Incremental Cost Effectiveness Ratio (ICER) was done after ranking the strategies in order of the increasing effectiveness (total infections averted). The findings shows that for the endemic regions the combination of ITNs, IRS, and IPTp was the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment and IRS; for seasonal areas is the use of ITNs plus treatment; and for the low risk areas is the use of treatment only. Malaria transmission in Kenya can be minimized through tailor-made intervention strategies for malaria control which produces health improvements in the most cost effective way for different epidemiological zones. This offers the good value for money for the public health programs and can guide in the allocation of malaria control resources for the post-2015 malaria eradication strategies and the achievement of the Sustainable Development Goals.

Highlights

Malaria is a leading cause of mortality and morbidity among the under-five and the pregnant women in Sub Saharan Africa [1]
The parameters in the Model (1) were estimated using clinical malaria data and demographics statistics of Kenya. Those that were not available were obtained from literature published by researchers in malaria endemic countries which have similar environmental conditions compare to Kenya
Repeating the same procedure for the remaining epidemiological zones, the findings shows that for the endemic regions the combination of insecticide treated bed nets (ITNs) u1, indoor residual spraying (IRS) u3, and intermittent preventive treatment for pregnant women (IPTp) u4 is the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment u2, and IRS

Summary

Introduction

Malaria is a leading cause of mortality and morbidity among the under-five and the pregnant women in Sub Saharan Africa [1]. These groups are at high risk due to weakened and immature immunity respectively. The need for value of money calls for the cost effective analysis of malaria interventions. This will contribute to effective ways of controlling the spread of malaria in Kenya. Malaria transmission is highly variable across Kenya because of the different transmission intensities driven by climate and temperature. Kenya has four malaria epidemiological zones; the endemic areas, the seasonal malaria transmission, the malaria epidemic prone areas and the low risk malaria areas [2,3]

Results

Discussion

Conclusion