Abstract
BackgroundMalaria programmes in countries with low transmission levels require evidence to optimize deployment of current and new tools to reach elimination with limited resources. Recent pilots of elimination strategies in Ethiopia, Senegal, and Zambia produced evidence of their epidemiological impacts and costs. There is a need to generalize these findings to different epidemiological and health systems contexts.MethodsDrawing on experience of implementing partners, operational documents and costing studies from these pilots, reference scenarios were defined for rapid reporting (RR), reactive case detection (RACD), mass drug administration (MDA), and in-door residual spraying (IRS). These generalized interventions from their trial implementation to one typical of programmatic delivery. In doing so, resource use due to interventions was isolated from research activities and was related to the pilot setting. Costing models developed around this reference implementation, standardized the scope of resources costed, the valuation of resource use, and the setting in which interventions were evaluated. Sensitivity analyses were used to inform generalizability of the estimates and model assumptions.ResultsPopulated with local prices and resource use from the pilots, the models yielded an average annual economic cost per capita of $0.18 for RR, $0.75 for RACD, $4.28 for MDA (two rounds), and $1.79 for IRS (one round, 50% households). Intervention design and resource use at service delivery were key drivers of variation in costs of RR, MDA, and RACD. Scale was the most important parameter for IRS. Overall price level was a minor contributor, except for MDA where drugs accounted for 70% of the cost. The analyses showed that at implementation scales comparable to health facility catchment area, systematic correlations between model inputs characterizing implementation and setting produce large gradients in costs.ConclusionsProspective costing models are powerful tools to explore resource and cost implications of policy alternatives. By formalizing translation of operational data into an estimate of intervention cost, these models provide the methodological infrastructure to strengthen capacity gap for economic evaluation in endemic countries. The value of this approach for decision-making is enhanced when primary cost data collection is designed to enable analysis of the efficiency of operational inputs in relation to features of the trial or the setting, thus facilitating transferability.
Highlights
Malaria programmes in countries with low transmission levels require evidence to optimize deployment of current and new tools to reach elimination with limited resources
in-door residual spraying (IRS) entails insecticidal spraying of surfaces in inhabited houses; deployment of IRS for elimination is conducted by district teams in a subset of houses targeted by malaria incidence
To the extent that the introduction of RR in a given setting alters the workload of the community cadre or requires other additional resources, the corresponding inputs of the costing model would need to be updated to adequately capture these additional costs
Summary
Malaria programmes in countries with low transmission levels require evidence to optimize deployment of current and new tools to reach elimination with limited resources. Between 2013 and 2015 the Malaria Control and Elimination Partnership in Africa at PATH (MACEPA), together with country programmes, conducted field trials in Zambia [8,9,10,11], Senegal [12], and Ethiopia to evaluate the individual and synergistic effects of malaria interventions on transmission interruption. Within these trials, scale-up and optimization of routine malaria preventive interventions were evaluated alongside strategies for malaria surveillance, and both population-wide and focal approaches to clearing parasites from people. Programmes require tools to transfer and relate findings from these pilots to the specific contexts and the capacity constraints in which they operate in order to formulate adequate strategies toward elimination targets
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.