Cost-effectiveness of malaria control in sub-Saharan Africa

Background Information on the cost-effectiveness of malaria control is need ed for the WHO Roll Back Malaria campaign, but is sparse. We used mathemati cal models to calculate cost-effectiveness ratios for the main prevention a nd treatment interventions in sub-Saharan Africa. Methods We analysed interventions to prevent malaria in childhood (insectic ide-treated nets, residual spraying of houses, and chemoprophylaxis) and pr egnancy (chloroquine chemoprophylaxis and sulfadoxine-pyrimethamine intermi ttent treatment), and to improve malaria treatment (improved compliance, im proved availability of second-line and third-line drugs, and changes in fir st-line drug). We developed models that included probabilistic sensitivity analysis to calculate ranges for the cost per disability-adjusted life year (DALY) averted for each intervention in three economic strata. Data were o btained from published and unpublished sources, and consultations with rese archers and programme managers. Findings In a very-low-income country, for insecticide treatment of existin g nets, the cost-effectiveness range was US$4-10 per DALY averted; for prov ision of nets and insecticide treatment $19-85; for residual spraying (two rounds per year) $32-58; for chemoprophylaxis for children $3-12 (assuming an existing delivery system); for intermittent treatment of pregnant women $4-29; and for improvement in case management $1-8. Although some intervent ions are inexpensive, achieving high coverage with an intervention to preve nt childhood malaria would use a high proportion of current health-care exp enditure. Interpretation Cost-effective interventions are available. A package of int erventions:to decrease the bulk of the malaria burden is not, however, affo rdable in very-low-income countries. Coverage of the most vulnerable groups in Africa will require substantial assistance from external donors.