Costs and consequences of large-scale vector control for malaria.

Joshua Yukich ,Jo-Ann Mulligan,Brian Sharp,Dirk H Mueller,Tewolde Ghebremeskel,Catherine Goodman,Warren Stevens,Juan Manuel Urrutia,Mehari Zerom,Des Chavasse,Kara Hanson,Virginia Wiseman,David Mcguire,Fana Sakho,Fabrizio Tediosi,Marcy Erskine,Christian Lengeler,Lesong Conteh,John Justino,Rajendra Maharaj,Nick Brown

doi:10.1186/1475-2875-7-258

Abstract

BackgroundFive large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology.MethodsCosts were measured locally or derived from existing studies and focused on the provider perspective, but included the direct costs of net purchases by users, and are reported in 2005 USD. Effectiveness was estimated by combining programme outputs with standard impact indicators.FindingsConventional ITNs: The cost per treated net-year of protection ranged from USD 1.21 in Eritrea to USD 6.05 in Senegal. The cost per child death averted ranged from USD 438 to USD 2,199 when targeting to children was successful.Long-lasting insecticidal nets (LLIN) of five years duration: The cost per treated-net year of protection ranged from USD 1.38 in Eritrea to USD 1.90 in Togo. The cost per child death averted ranged from USD 502 to USD 692.IRS: The costs per person-year of protection for all ages were USD 3.27 in KwaZulu Natal and USD 3.90 in Mozambique. If only children under five years of age were included in the denominator the cost per person-year of protection was higher: USD 23.96 and USD 21.63. As a result, the cost per child death averted was higher than for ITNs: USD 3,933–4,357.ConclusionBoth ITNs and IRS are highly cost-effective vector control strategies. Integrated ITN free distribution campaigns appeared to be the most efficient way to rapidly increase ITN coverage. Other approaches were as or more cost-effective, and appeared better suited to "keep-up" coverage levels. ITNs are more cost-effective than IRS for highly endemic settings, especially if high ITN coverage can be achieved with some demographic targeting.

Highlights

Five large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology
All the ITN programmes were larger in terms of population protected than the two IRS programmes
If nets were to only protect children little community effect would be realized as children represent less than 20% of the population in sub-Saharan Africa [45]. Under any scenario these findings suggest that long-lasting insecticidal nets (LLINs) are more costeffective in high endemicity settings compared to IRS

Summary

Introduction

Five large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology. Prevention of malaria in highly endemic countries relies largely on vector control through one of two main methods: insecticide treated (mosquito) nets (ITNs) and indoor residual (house) spraying (IRS). Both methods are known to be highly effective and current evidence suggests they are very similar in their impact [1]. While few countries were near this objective in 2007, substantial progress has been made This has been accompanied by vigorous debate as to the best way forward with regard to the different implementation models for ITNs, as well as the relative merits of ITNs versus IRS [3,4,5,6,7,8]. While the implementation of IRS is typically through vertical programmes, available options for ITN implementation are more diverse

Methods

Results

Conclusion