Bringing malaria diagnosis and treatment closer to the people: economic rationale for expanding malaria community case management to all ages in a rural district in Madagascar

Walter Ochieng, Julie Gutman, Catherine Dentinger, Aina Harimanana, Judickaelle Irinantenaina, Hobisoa Razanadranaivo, Oméga Raobela, Aline Mukerabirori, Laurent Kapesa, Andres Garchitorena () and Laura Steinhardt
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Walter Ochieng: CDC - Centers for Disease Control and Prevention [Atlanta, Ga., USA]
Judickaelle Irinantenaina: Institut Pasteur de Madagascar - Pasteur Network (Réseau International des Instituts Pasteur)
Andres Garchitorena: Institut Pasteur de Madagascar - Pasteur Network (Réseau International des Instituts Pasteur)
Laura Steinhardt: CDC - Centers for Disease Control and Prevention [Atlanta, Ga., USA]

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Abstract: Background Expanding malaria community case management (mCCM) to all ages could shift the point-ofcare to the community leading to improved healthcare access in underserved populations. This study assesses the economic viability of such an expansion in Farafangana district, Madagascar.Methods A cluster-randomized trial was conducted across 30 health centres and the 502 community health workers (CHW) in their catchment areas, with the intervention arm implementing the age-expanded mCCM intervention. CHWs across both arms received training, supplies, and supervision to manage malaria. An economic evaluation assessed cost-effectiveness from health sector and societal perspectives, measuring outcomes in disability-adjusted life years (DALYs) averted. The impact of CHW compensation and economic risks were evaluated using sensitivity analyses. ResultsWithout CHW compensation, annual costs were $794,000, primarily for antimalarials and diagnostic tests. Incremental cost-effectiveness ratios (ICERs) per DALY averted ranged from -$21.86 to $212.42. From a societal perspective, the ICER was -$135.64, and -$243.29 including mortality benefits, meaning the intervention was costsaving. The programme could avert 99.6 deaths and 3,721.7 DALYs annually, yielding $1,172,283 in net economic benefits. Sensitivity analyses supported these findings.Conclusions Age-expanded mCCM is highly cost-effective and can enhance malaria treatment access in resourcelimited settings.

Keywords: Malaria Community case management Madagascar Economics; Malaria; Community case management; Madagascar; Economics (search for similar items in EconPapers)
Date: 2025-05-04
New Economics Papers: this item is included in nep-mac
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Published in Malaria Journal, 2025, 24, ⟨10.1186/s12936-025-05381-y⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05072802

DOI: 10.1186/s12936-025-05381-y

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