Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign

Dirk H Mueller¹ , Virginia Wiseman¹ , Dankom Bakusa² , Kodjo Morgah³ , Aboudou Daré⁴ and Potougnima Tchamdja⁵

¹Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, UK

²Division of Planning, Togolese Ministry of Health, Lomé, Republic of Togo

³National Malaria Control Programme, Togolese Ministry of Health, Lomé, Republic of Togo

⁴Division of Family Health, Togolese Ministry of Health, Lomé, Republic of Togo

⁵Director General, Togolese Ministry of Health, Lomé, Republic of Togo

author email corresponding author email

Malaria Journal 2008, 7:73doi:10.1186/1475-2875-7-73


Published:	29 April 2008

Abstract

Background

To evaluate the cost-effectiveness of the first nationwide delivery of long-lasting insecticide-treated nets (LLITNs) as part of the 2004 measles vaccination campaign in Togo to all children between nine months and five years.

Methods

An incremental approach was used to calculate the economic costs and effects from a provider perspective. Effectiveness was estimated in terms of malaria cases averted, deaths averted and Disability-Adjusted Life Years (DALYs) averted. Malaria cases were modelled using regional estimates. Programme and treatment costs were derived through reviews of financial records and interviews with key stakeholders. Uncertain variables were subjected to a univariate sensitivity analysis.

Results

Assuming equal attribution of shared costs between the LLITN distribution and the measles vaccination, the net costs per LLITN distributed were 4.41 USD when saved treatment costs were taken into account. Assuming a constant utilization of LLITNs by the target group over three years, 1.2 million cases could be prevented at a net cost per case averted of 3.26 USD. The net costs were 635 USD per death averted and 16.39 USD per DALY averted, respectively.

Conclusion

The costs per case, death and DALY averted are well within commonly agreed benchmarks set by other malaria prevention studies. Varying transmission levels are shown to have a significant impact on cost-effectiveness ratios. Results also suggest that substantial efficiency gains may be derived from the joint delivery of vaccination campaigns and malaria interventions.