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Comparative Study
. 2008 Dec 17:7:258.
doi: 10.1186/1475-2875-7-258.

Costs and consequences of large-scale vector control for malaria

Joshua O Yukich  1 , Christian Lengeler, Fabrizio Tediosi, Nick Brown, Jo-Ann Mulligan, Des Chavasse, Warren Stevens, John Justino, Lesong Conteh, Rajendra Maharaj, Marcy Erskine, Dirk H Mueller, Virginia Wiseman, Tewolde Ghebremeskel, Mehari Zerom, Catherine Goodman, David McGuire, Juan Manuel Urrutia, Fana Sakho, Kara Hanson, Brian Sharp
Affiliations
Comparative Study

Costs and consequences of large-scale vector control for malaria

Joshua O Yukich et al. Malar J. .

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.

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Figures

Figure 1
Figure 1
Cost-effectiveness results of shifting to long-lasting insecticidal nets. Cost-effectiveness results of shifting to three-year (USD 5) or five-year (USD 7) long-lasting insecticidal nets (LLINs) relative to conventional ITN estimates. LLIN CE estimates do not include protection from re-treatment kits but may include some costs associated with their distribution (see main text).
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