Cost effectiveness and resource allocation of Plasmodium falciparum malaria control in Myanmar: a modelling analysis of bed nets and community health workers

Abstract

Background: Funding for malaria control and elimination in Myanmar has increased markedly in recent years. While there are various malaria control tools currently available, two interventions receive the majority of malaria control funding in Myanmar: (1) insecticide-treated bed nets and (2) early diagnosis and treatment through malaria community health workers. This study aims to provide practical recommendations on how to maximize impact from investment in these interventions.

Methods: A simple decision tree is used to model intervention costs and effects in terms of years of life lost. The evaluation is from the perspective of the service provider and costs and effects are calculated in line with standard methodology. Sensitivity and scenario analysis are undertaken to identify key drivers of cost effectiveness. Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model.

Findings: Community health workers have the potential for high impact on malaria, particularly where there are few alternatives to access malaria treatment, but are relatively costly. Insecticide-treated bed nets are comparatively inexpensive and modestly effective in Myanmar, representing a low risk but modest return intervention. Unlike some healthcare interventions, bed nets and community health workers are not mutually exclusive nor are they necessarily at their most efficient when universally applied. Modelled resource allocation scenarios highlight that in this case there is no "one size fits all" cost effectiveness result. Health gains will be maximized by effective targeting of both interventions.

Fig. 1

Probability tree model of cost and impact for malaria community health workers and bed nets

Fig. 2

Costs and effects of malaria control in different accessibility scenarios. Circle indicates a dominated intervention. E easily accessible, M moderately accessible, D difficult to access, V very difficult to access

Fig. 3

Change in CHW cost effectiveness: univariate sensitivity analysis of all relevant parameters

Fig. 4

Change in bed net cost effectiveness: univariate sensitivity analysis of all relevant parameters

Fig. 5

Township allocation of malaria interventions in the MARC region, Myanmar. Legends: Maps indicate allocation of US$ 10 million to bed nets and malaria community health workers in the MARC region, Myanmar. a Allocation using default parameter values detailed in Table 1. b Allocation assuming a lower bed net protective effect of 5 %. c Allocation assuming a higher uptake of community health workers; 95 % of malaria infections. d Allocation assuming 50 % cost-sharing for community health workers. For panels (b–d) all parameters other than the specified variation are the default values outlined in Table 1