The application of cost-effectiveness analysis to disease control programmes in developing countries, with special reference to malaria control in Nepal.

Abstract

The aims of this research study are three-fold: 1. to explore the relevance of recent developments In the methodology of cost-effectiveness analysis to disease control programmes In developing countries and specifically to malaria control in Nepal; 2. to apply cost-effectiveness analysis to the malaria control programme in Nepal in terms both of (a) the cost-effectiveness of various malaria control strategies and (b) the cost-effectiveness of the malaria control programme as a whole, in order to refine a methodology capable of more general application to disease control programmes in developing countries; 3. to assess whether policy-relevant conclusions can be drawn from the application of cost-effectiveness analysis to the malaria control programme in Nepal. The thesis is structured as follows. After the first introductory chapter, Chapter 2 reviews the literature on the cost-effectiveness analysis of disease control programmes, considering first the methodology of cost-effectiveness analysis, then its application to disease control programmes in first developed and then developing countries, and finally its application to malaria control. Chapter 3 briefly describes the epidemiology of malaria and policies and strategies of control before considering the history of malaria control in Nepal, present malaria control strategies and economic characteristics of the control programme. In Chapter 4, objectives and methods are presented for the study of malaria control in Nepal with a description of the theoretical framework of the analysis followed by a description of the various sub-studies, comprising a cost analysis, an effectiveness analysis and two surveys of malaria patients. The findings are presented in three chapters. The first (Chapter 5) presents the results of an analysis of the recurrent expenditure of NMEO (Nepal Malaria Eradication Organization) districts. The second assesses the internal efficiency of the Nepalese malaria control programme, considering first vector control strategies and second case detection and treatment strategies. The following chapter (Chapter 7) presents results relating to the desirability of malaria control (as opposed to other Investments). These results are discussed in Chapter 8 in terms both of the application of the cost-effectiveness methodology and of the findings In Nepal. Chapter 9 then draws out the Implications of the findings for malaria control policies and strategies In Nepal. In Chapter 10, conclusions are drawn relating to the three alms of the research study Identified above and recommendations are given. Finally, Chapter 11 draws out the Implications of this study for further research.