CSU 53/2010: COST EFFECTIVENESS OF INTEGRATED LLIN DISTRIBUTION IN TOGO

Tuesday, 4th of May 2010

In this analysis, based on the the Togolese Child Health campaign, Mueller and colleagues make the case for reducing overhead costs by spreading them over multiple interventions, notably bednet distribution and measles vaccination.

An intriguing idea. Will integrated distribution still work when

1) dates of bednet arrivals are less reliably predictable than dates of vaccine arrivals

2) bednet campaigns, with univeral coverage, now no longer target the same under-fives as are targeted in Child Health Days for measles vaccination, vitamin A, and antihelminthics.

Abstract follows. Full text is at http://www.malariajournal.com/content/7/1/73

Good reading.

Bob Davis

‘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

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

The electronic version of this article is the complete one and can be found online at: http://www.malariajournal.com/content/7/1/73

Received:	28 January 2008
Accepted:	29 April 2008
Published:	29 April 2008

© 2008 Mueller et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.