Systematic review and meta-analysis of the cost and cost-effectiveness of distributing insecticide-treated nets for the prevention of malaria

Acta Trop. 2020 Feb;202:105229. doi: 10.1016/j.actatropica.2019.105229. Epub 2019 Oct 24.


Insecticide-treated nets are one of two core vector control interventions recommended by the World Health Organization for deployment in malaria-endemic regions around the world, especially sub-Saharan Africa. Although there are many factors that influence the type of distribution strategy chosen, among the most important considerations for the type of distribution strategy chosen is cost, both in terms of total expenditure required and in terms of relative cost-effectiveness. This research attempted to inform these decisions by conducting a systematic review and meta-analysis of the literature on the cost and cost-effectiveness of ITN distribution. The analysis compared the relative cost and cost-effectiveness of distribution strategies. Findings suggest that mass campaigns have lower average distribution costs per net compared with continuous/health facility distribution or sale/vouchers, although the relationship between distribution channel and cost were not statistically significant in the multivariate regression models. Continuous/health facility distribution channels were found to be more cost-effective than mass campaigns for averting DALYs, death, and cases of malaria. Those who design and budget for malaria programs should base decisions about distribution channels more on operational and epidemiological considerations than on cost per net, as the costs per net between distribution channels are not statistically different.

Keywords: Cost; Cost effectiveness; Insecticide-Treated Bed Nets; Malaria; Meta-analysis; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Cost-Benefit Analysis
  • Humans
  • Insecticide-Treated Bednets / economics*
  • Insecticides / pharmacology*
  • Malaria / epidemiology*
  • Malaria / prevention & control*
  • Mosquito Control / methods*


  • Insecticides