Cost-effectiveness of district-wide seasonal malaria chemoprevention when implemented through routine malaria control programme in Kita, Mali using fixed point distribution

Halimatou Diawara, Patrick Walker, Matt Cairns, Laura Steinhardt, Fatou Diawara, Beh Kamate, Laetitia Duval, Elisa Sicuri, Issaka Sagara, Aboubacar Sadou, Jules Mihigo, Erin Eckert, Alassane Dicko and Lesong Conteh
Additional contact information
Halimatou Diawara: USTTB - Université des Sciences, des Techniques et des Technologies de Bamako
Patrick Walker: Imperial College London
Matt Cairns: LSHTM - London School of Hygiene and Tropical Medicine
Laura Steinhardt: CDC - Centers for Disease Control and Prevention [Atlanta] - Centers for Disease Control and Prevention
Fatou Diawara: USTTB - Université des Sciences, des Techniques et des Technologies de Bamako
Beh Kamate: Save the Children, Bamako, Mali
Elisa Sicuri: Imperial College London
Issaka Sagara: USTTB - Université des Sciences, des Techniques et des Technologies de Bamako
Aboubacar Sadou: US AID - US Agency for International Development [Kinshasa]
Jules Mihigo: US AID - US Agency for International Development [Kinshasa]
Erin Eckert: US AID - US Agency for International Development [Kinshasa]
Alassane Dicko: USTTB - Université des Sciences, des Techniques et des Technologies de Bamako
Lesong Conteh: LSE - London School of Economics and Political Science

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Abstract: Background: 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. 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. Methods: Cost 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. Results: The 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. Conclusions: When 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.

Keywords: Malaria; Mali; Seasonal malaria chemoprevention; Cost; Cost-effectiveness; Economic; Financial; Disability-adjusted life year (DALY) (search for similar items in EconPapers)
Date: 2021
Note: View the original document on HAL open archive server: https://hal.science/hal-03184961
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Published in Malaria Journal, 2021, 20, pp.128. ⟨10.1186/s12936-021-03653-x⟩

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Working Paper: Cost-effectiveness of district-wide seasonal malaria chemoprevention when implemented through routine malaria control programme in Kita, Mali using fixed point distribution (2021)
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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03184961

DOI: 10.1186/s12936-021-03653-x

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