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Randomized Controlled Trial
. 2015 May 20;14:211.
doi: 10.1186/s12936-015-0722-3.

Costs and Cost-Effectiveness of a Large-Scale Mass Testing and Treatment Intervention for Malaria in Southern Province, Zambia

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Free PMC article
Randomized Controlled Trial

Costs and Cost-Effectiveness of a Large-Scale Mass Testing and Treatment Intervention for Malaria in Southern Province, Zambia

Kafula Silumbe et al. Malar J. .
Free PMC article

Abstract

Background: A cluster, randomized, control trial of three dry-season rounds of a mass testing and treatment intervention (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in four districts in Southern Province, Zambia.

Methods: Data were collected on the costs and logistics of the intervention and paired with effectiveness estimated from a community randomized control trial for the purpose of conducting a provider perspective cost-effectiveness analysis of MTAT vs no MTAT (Standard of Care).

Results: Dry-season MTAT in this setting did not reduce malaria transmission sufficiently to permit transition to a case-investigation strategy to then pursue malaria elimination, however, the intervention did substantially reduce malaria illness and was a highly cost-effective intervention for malaria burden reduction in this moderate transmission area. The cost per RDT administered was estimated to be USD4.39 (range: USD1.62-13.96) while the cost per AL treatment administered was estimated to be USD34.74 (range: USD3.87-3,835). The net cost per disability adjusted life year averted (incremental cost-effectiveness ratio) was estimated to be USD804.

Conclusions: The intervention appears to be highly cost-effective relative to World Health Organization thresholds for malaria burden reduction in Zambia as compared to no MTAT. However, it was estimated that population-wide mass drug administration is likely to be more cost-effective for burden reduction and for transmission reduction compared to MTAT.

Figures

Fig. 1
Fig. 1
Map of Southern Province districts, health facilities and their catchment areas included in training and testing campaigns and trial
Fig. 2
Fig. 2
Distribution of costs by district
Fig. 3
Fig. 3
Cost per test and treatment administered versus prevalence. Red represents cost per test administered and green represents cost per treatment administered
Fig. 4
Fig. 4
Cost per treatment administered versus catchment population size
Fig. 5
Fig. 5
Sensitivity analysis of effect size and cost variance. Hex-bins represent simulated cost and DALY averted outcomes, with lighter colour indicating higher density of simulations, black lines are the x and y-axes of the chart. The green line is the WHO threshold for an intervention to be considered highly cost-effective in Zambia (USD 1,414 per DALY averted) and the red line is the threshold at which an intervention is considered cost-effective or not cost-effective in Zambia (3x GDP per capita) (USD 4,242 per DALY averted)
Fig. 6
Fig. 6
Probabilistic sensitivity analysis results shown as a cost-effectiveness acceptability curve. The vertical dotted lines represent the WHO thresholds for an intervention to be considered highly cost-effective and cost-effective in Zambia: (USD 1,414 per DALY averted) and (USD 4,242 per DALY averted), respectively

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References

    1. WHO . World Malaria Report 2013. Geneva: World Health Organization; 2013.
    1. Das P, Horton R. Malaria elimination: worthy, challenging, and just possible. Lancet. 2010;376:1515–7. doi: 10.1016/S0140-6736(10)61551-6. - DOI - PubMed
    1. Moonen B, Cohen JM, Snow RW, Slutsker L, Drakeley C, Smith DL, et al. Operational strategies to achieve and maintain malaria elimination. Lancet. 2010;376:1592–1603. doi: 10.1016/S0140-6736(10)61269-X. - DOI - PMC - PubMed
    1. Ministry of Health Zambia . National malaria control programme strategic plan for 2011–2015: “Consolidating malaria gains for impact”. Lusaka, Zambia: National Malaria Control Programme; 2011.
    1. Ministry of Health Zambia . National Malaria Indicator Survey. 2010.

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