Research

Costs and consequences of large-scale vector control for malaria

Joshua O Yukich¹ , Christian Lengeler¹ , Fabrizio Tediosi^1,2 , Nick Brown^1,3 , Jo-Ann Mulligan⁴ , Des Chavasse⁵ , Warren Stevens⁶ , John Justino⁷ , Lesong Conteh^1,4 , Rajendra Maharaj⁸ , Marcy Erskine⁹ , Dirk H Mueller⁴ , Virginia Wiseman⁴ , Tewolde Ghebremeskel¹⁰ , Mehari Zerom¹⁰ , Catherine Goodman^4,11 , David McGuire¹² , Juan Manuel Urrutia¹³ , Fana Sakho¹⁴ , Kara Hanson⁴ and Brian Sharp^{^}

¹  Department of Public Health and Epidemiology, Swiss Tropical Institute, P.O. Box, 4002 Basel, Switzerland

²  Centre for Research on Health and Social Care Management, Università Bocconi, Milan, Italy

³  ITN Cell, National Malaria Control Programme, Ministry of Health, Dar Es Salaam, Tanzania

⁴  Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

⁵  Population Services International, Nairobi, Kenya

⁶  Medical Research Council Laboratories, Banjul, Gambia

⁷  Population Services International, Blantyre, Malawi

⁸  Malaria Lead Programme, Medical Research Council of South Africa, Durban, KwaZulu-Natal, South Africa

⁹  Canadian Red Cross, Ottawa, Ontario, Canada

¹⁰  National Malaria Control Programme, Ministry of Health, P.O. Box 212, Asmara, Eritrea

¹¹  KEMRI/Wellcome Trust Programme, PO Box 43640, Nairobi, Kenya

¹²  Abt Associates Inc., Bethesda, MD, USA

¹³  NetMark Partnership, Academy for Educational Development, Johannesburg, South Africa

¹⁴  NetMark Partnership, Academy for Educational Development, Dakar, Senegal

author email corresponding author email^Deceased

Malaria Journal 2008, 7:258doi:10.1186/1475-2875-7-258

Published:	17 December 2008

Abstract

Background

Five large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology.

Methods

Costs 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.

Findings

Conventional 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.

Conclusion

Both 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.