Cost Effectiveness of Long-Lasting Insecticide Treated Bed Nets Distribution in Prevention of Malaria Deaths and Morbidity in Guyana
Abstract:
Malaria continues to pose a significant public health and economic threat in Guyana. In response, over 90,000 Long-Lasting Insecticide Nets (LLINs) were distributed in endemic regions in 2018 to curb malaria incidence. This study conducted a cost-effectiveness analysis from the provider’s perspective, comparing the LLIN campaign to a no-intervention scenario. A model-based economic evaluation was used, incorporating cost per LLIN distributed, deaths averted, and disability-adjusted life years (DALYs) averted. The average cost of delivering one LLIN was US$3.29. The intervention averted an estimated 387.42 under-five deaths annually and 1,162.3 over three years. The annual cost per death averted was US$129.84, decreasing to US$32.51 over three years. DALYs averted totaled 12,784.86 annually and 38,354.58 across three years. The estimated cost per DALY averted was US$3.93, significantly lower than Guyana’s 2017 GDP per capita of US$3,883, confirming the intervention’s high cost-effectiveness based on the WHO threshold. Sensitivity analyses showed the findings were robust despite variations in LLIN cost, life span, discount rate, and mortality impact. The study concludes that the LLIN campaign was a highly cost-effective malaria intervention and recommends its continuation. It further suggests that similar economic evaluations should be conducted for other preventive measures such as indoor residual spraying and larviciding.
References:
[1]. WHO,
2024, World Malaria Report-2024. Geneva: WHO.
[2]. White,
M. T., Conteh, L., Cibulskis, R., Ghani, A. C., 2011, Costs and
cost-effectiveness of malaria control interventions: a systematic review. Malaria
Journal, 10(1):337.
[3]. WHO,
2010, World Malaria Report-2010. Geneva: WHO.
[4]. United
Nations, 2015, Transforming our World: The 2030 Agenda for Sustainable
Development.
[5]. Guyana
Ministry of Public Health, 2016, Guyana National Malaria Strategic Plan
2016–2021.
[6]. Fonseca,
A. G., Carvalho, S., Dias, S., Baptista, J. L., Torgal, J., 2016, Understanding
the occupational traveller profile towards malaria prevention enables directed
health promotion and preventive practices. Int. J. Trop. Med. Public Health,
6. doi:10.5455/211930/ijtmph.
[7]. Ruktanonchai,
N. W., DeLeenheer, P., Tatem, A. J., et al., 2016, Identifying malaria
transmission foci for elimination using human mobility data. PLoS Comput.
Biol., 12(4):e1004846.
[8]. Global
Fund, 2016, Standard Concept Note: Investing for impact against HIV, tuberculosis
or malaria 2016–2019.
[9]. Snow,
R. W., Amratia, P., Kabaria, C. W., et al., 2012, The changing limits and
incidence of malaria in Africa: 1939–2009. Adv. Parasitol., 78:169–262.
[10]. Shafiee,
S., Topal, E., 2010, An overview of global gold market and gold price
forecasting. Resour. Policy, 35(3):178–189.
[11]. Broom,
M., Rychtář, J., Spears-Gill, T., 2016, The Game-Theoretical Model of Using
Insecticide-Treated Bed-Nets to Fight Malaria. Appl. Math.,
7(9):852–860.
[12]. Katureebe,
A., Zinszer, K., Arinaitwe, E., et al., 2016, Measures of malaria burden after
LLIN distribution and IRS at three sites in Uganda: A prospective observational
study. PLoS ONE. Available at: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002167
[Accessed 4 Dec 2018].
[13]. Lengeler,
C., 2004, Insecticide-treated bed nets and curtains for preventing malaria. Cochrane
Database Syst. Rev., 2:CD000363.
[14]. UNICEF,
Guyana Bureau of Statistics, Ministry of Public Health, 2014, Guyana Multiple
Indicator Cluster Survey. Available at: http://microdata.worldbank.org/index.php
[Accessed 4 Nov. 2018].
[15]. Paintain,
L. S., Awini, E., Addei, S., et al., 2014, Evaluation of a universal LLIN
distribution campaign in Ghana: cost effectiveness of distribution and hang-up
activities. Malaria J., 13(1):71.
[16]. WHO,
Global Malaria Programme, 2007, Insecticide-treated mosquito nets: a WHO
position statement. Geneva: WHO.
[17]. Roll
Back Malaria Partnership, 2008, The Global Malaria Action Plan – For a
malaria-free world.
[18]. WHO,
2011, Continuous long-lasting insecticidal net distributions: A guide to
concepts and planning. Available at: http://www.vector-works.org/wp-content/uploads/3-Guide_to_continuous_distribution_strategy_ENGLISH_FINAL_0.pdf.
[19]. Bertram,
M. Y., Lauer, J. A., De Joncheere, K., et al., 2016, Cost–effectiveness
thresholds: pros and cons. Bull. World Health Organ., 94(12):925–930.
[20]. Jit,
M., Brisson, M., Portnoy, A., Hutubessy, R., 2014, Cost-effectiveness of female
HPV vaccination in 179 countries: a PRIME modelling study. Lancet Glob.
Health, 2:e406–e414.
[21]. Drummond,
M. F., Sculpher, M. J., Torrance, G., et al., 2005, Methods for the Economic
Evaluation of Health Care Programmes. New York: Oxford University Press.
[22]. Mueller,
D. H., Wiseman, V., Bakusa, D., et al., 2008, Cost-effectiveness analysis of
ITN distribution as part of the Togo Integrated Child Health Campaign. Malaria
J., 7(1):73.
[23]. Yukich,
J. O., Zerom, M., Ghebremeskel, T., et al., 2009, Costs and cost-effectiveness
of vector control in Eritrea using ITNs. Malaria J., 8(1):51.
[24]. Ngugi,
I. K., Chiguzo, A. N., Guyatt, H. L., 2004, A cost analysis of the
employer-based bed net programme in Coastal and Western Kenya. Health Policy
Plan., 19:111–119.
[25]. Gama,
E., Were, V., Ouma, P., et al., 2016, Large-scale implementation of disease
control programmes: a cost-effectiveness analysis of LLIN distribution channels
in Kenya—a study protocol. BMJ Open, 6:e012776.
doi:10.1136/bmjopen-2016-012776.
[26]. Hanson,
K., Kikumbih, N., Schellenberg, J. A., et al., 2003, Cost-effectiveness of
social marketing of ITNs in the United Republic of Tanzania. Bull. World
Health Organ., 81:269–276.
[27]. Goodman,
C. A., Mnzava, A. E., Dlamini, S. S., et al., 2001, Comparison of cost and
cost-effectiveness of ITNs and residual house spraying in South Africa. Trop.
Med. Int. Health, 6(4):280–295.
[28]. Baltussen,
R. M., Adam, T., Tan-Torres Edejer, T., et al., 2003, Making choices in health:
WHO guide to cost-effectiveness analysis. Geneva: WHO.
[29]. Bertram,
M. Y., Lauer, J. A., De Joncheere, K., et al., 2016, Cost-effectiveness
thresholds: pros and cons. Bull. World Health Organ., 94(12):925–930.
doi:10.2471/BLT.15.164418.
[30]. Husereau,
D., Drummond, M., Petrou, S., et al., 2013, CHEERS statement: Explanation and
elaboration. Value Health, 16(2):231–250.
[31]. Broom,
M., Rychtář, J., Spears-Gill, T., 2016, The Game-Theoretical Model of Using
Insecticide-Treated Bed-Nets to Fight Malaria. Appl. Math.,
7(9):852–860.
[32]. Bureau
of Statistics, 2012, Guyana National Census 2012.
[33]. Hay, S. I., Snow, R. W., Rogers, D. J., 1998, From predicting mosquito habitat to malaria seasons using remotely sensed data. Parasitol. Today, 14(8):306–313.
