Abstract
BackgroundThe control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment (IPT), diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness.MethodsA systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives.ResultsFifty-five studies of the costs and forty three studies of the cost-effectiveness of malaria interventions were identified, 78% of which were undertaken in sub-Saharan Africa, 18% in Asia and 4% in South America. The median financial cost of protecting one person for one year was $2.20 (range $0.88-$9.54) for ITNs, $6.70 (range $2.22-$12.85) for IRS, $0.60 (range $0.48-$1.08) for IPT in infants, $4.03 (range $1.25-$11.80) for IPT in children, and $2.06 (range $0.47-$3.36) for IPT in pregnant women. The median financial cost of diagnosing a case of malaria was $4.32 (range $0.34-$9.34). The median financial cost of treating an episode of uncomplicated malaria was $5.84 (range $2.36-$23.65) and the median financial cost of treating an episode of severe malaria was $30.26 (range $15.64-$137.87). Economies of scale were observed in the implementation of ITNs, IRS and IPT, with lower unit costs reported in studies with larger numbers of beneficiaries. From a provider perspective, the median incremental cost effectiveness ratio per disability adjusted life year averted was $27 (range $8.15-$110) for ITNs, $143 (range $135-$150) for IRS, and $24 (range $1.08-$44.24) for IPT.ConclusionsA transparent evidence base on the costs and cost-effectiveness of malaria control interventions is provided to inform rational resource allocation by donors and domestic health budgets and the selection of optimal packages of interventions by malaria control programmes.
Highlights
The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment (IPT), diagnostic testing and appropriate treatment
In this review IPT is used as an umbrella term for intermittent preventive treatment in infants (IPTi), in children (IPTc), and in pregnant women (IPTp)
There has not been a review of actual costs and CE of malaria treatment and prevention programmes in the last decade, despite the fact that these are likely to have changed with increasing economies of scale, and evolving market dynamics of the relatively new long-lasting insecticidal nets (LLINs), artemisinin combination therapy (ACT) and rapid diagnostic tests (RDTs)
Summary
The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment (IPT), diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. In this review IPT is used as an umbrella term for intermittent preventive treatment in infants (IPTi), in children (IPTc), and in pregnant women (IPTp). Having identified a range of interventions with proven efficacy, the challenge remains to scale-up their implementation in a sustainable, cost-effective and equitable manner. Decisions affecting the selection and coverage of interventions need to be taken in a rational, transparent manner using the best available evidence on efficacy, cost and cost-effectiveness. Morel et al [22] made another significant contribution to the literature by using a model based on WHO CHOICE country estimates of general health care utilization costs [23] to estimate the cost-effectiveness of packages of malaria prevention and treatment interventions. The need for such a review is timely given the changing global financial commitment to malaria [1,24] and the need for country-level decision making on which of the increasing number of tools have the greatest impact on reducing malaria with the minimum cost and are the most efficient use of resources
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