Abstract
BackgroundSeasonal malaria chemoprevention (SMC) is a strategy for malaria control recommended by the World Health Organization (WHO) since 2012 for Sahelian countries. The Mali National Malaria Control Programme adopted a plan for pilot implementation and nationwide scale-up by 2016. Given that SMC is a relatively new approach, there is an urgent need to assess the costs and cost effectiveness of SMC when implemented through the routine health system to inform decisions on resource allocation.MethodsCost data were collected from pilot implementation of SMC in Kita district, which targeted 77,497 children aged 3–59 months. Starting in August 2014, SMC was delivered by fixed point distribution in villages with the first dose observed each month. Treatment consisted of sulfadoxine-pyrimethamine and amodiaquine once a month for four consecutive months, or rounds. Economic and financial costs were collected from the provider perspective using an ingredients approach. Effectiveness estimates were based upon a published mathematical transmission model calibrated to local epidemiology, rainfall patterns and scale-up of interventions. Incremental cost effectiveness ratios were calculated for the cost per malaria episode averted, cost per disability adjusted life years (DALYs) averted, and cost per death averted.ResultsThe total economic cost of the intervention in the district of Kita was US $357,494. Drug costs and personnel costs accounted for 34% and 31%, respectively. Incentives (payment other than salary for efforts beyond routine activities) accounted for 25% of total implementation costs. Average financial and economic unit costs per child per round were US $0.73 and US $0.86, respectively; total annual financial and economic costs per child receiving SMC were US $2.92 and US $3.43, respectively. Accounting for coverage, the economic cost per child fully adherent (receiving all four rounds) was US $6.38 and US $4.69, if weighted highly adherent, (receiving 3 or 4 rounds of SMC). When costs were combined with modelled effects, the economic cost per malaria episode averted in children was US $4.26 (uncertainty bound 2.83–7.17), US $144 (135–153) per DALY averted and US $ 14,503 (13,604–15,402) per death averted.ConclusionsWhen implemented at fixed point distribution through the routine health system in Mali, SMC was highly cost-effective. As in previous SMC implementation studies, financial incentives were a large cost component.
Highlights
Seasonal malaria chemoprevention (SMC) is a strategy for malaria control recommended by the World Health Organization (WHO) since 2012 for Sahelian countries
In helping interpret whether SMC was cost effective we present our findings using two very conservative thresholds: (i) US $780.51, Mali’s 2016 Gross Domestic Product (GDP) per capita and (ii) an even more stringent World Bank threshold of US $250 per disability adjusted life years (DALYs) averted [29, 30]
Financial and economic cost were similar, the main difference being the already covered salary costs of facility-based health staff that were included in economic costs
Summary
Seasonal malaria chemoprevention (SMC) is a strategy for malaria control recommended by the World Health Organization (WHO) since 2012 for Sahelian countries. The Mali National Malaria Control Programme adopted a plan for pilot implementation and nationwide scale-up by 2016. In addition to the human morbidity and mortality impact, malaria places economic burdens on individuals, health systems and national governments. In Mali, malaria is the main cause of outpatient visits, hospitalizations and mortality in health facilities; children under five and pregnant women are the most affected [2]. According to a national survey in 2013, the prevalence of malaria parasitaemia by microscopy was 52% in children under 5 years overall in Mali and 37% in the southern region of Kayes, the setting of this study [3]. In 2014, health facilities across Mali registered more than two and half million cases of suspected malaria, of which 1.7 million were clinical cases, 800,000 severe cases and 2309 deaths [4]
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