Scaling up malaria intervention "packages" in Senegal: using cost effectiveness data for improving allocative efficiency and programmatic decision-making.
Malar J
; 17(1): 159, 2018 Apr 10.
Article
en En
| MEDLINE
| ID: mdl-29636051
ABSTRACT
BACKGROUND:
Senegal's National Malaria Control Programme (NMCP) implements control interventions in the form of targeted packages (1) scale-up for impact (SUFI), which includes bed nets, intermittent preventive treatment in pregnancy, rapid diagnostic tests, and artemisinin combination therapy; (2) SUFI + reactive case investigation (focal test and treat); (3) SUFI + indoor residual spraying (IRS); (4) SUFI + seasonal malaria chemoprophylaxis (SMC); and, (5) SUFI + SMC + IRS. This study estimates the cost effectiveness of each of these packages to provide the NMCP with data for improving allocative efficiency and programmatic decision-making.METHODS:
This study is a retrospective analysis for the period 2013-2014 covering all 76 Senegal districts. The yearly implementation cost for each intervention was estimated and the information was aggregated into a package cost for all covered districts. The change in the burden of malaria associated with each package was estimated using the number of disability adjusted life-years (DALYs) averted. The cost effectiveness (cost per DALY averted) was then calculated for each package.RESULTS:
The cost per DALY averted ranged from $76 to $1591 across packages. Using World Health Organization standards, 4 of the 5 packages were "very cost effective" (less than Senegal's GDP per capita). Relative to the 2 other packages implemented in malaria control districts, the SUFI + SMC package was the most cost-effective package at $76 per DALY averted. SMC seems to make IRS more cost effective $582 per DALY averted for SUFI + IRS compared with $272 for the SUFI + IRS + SMC package. The SUFI + focal test and treat, implemented in malaria elimination districts, had a cost per DALY averted of $1591 and was only "cost-effective" (less than three times Senegal's per capita GDP).CONCLUSION:
Senegal's choice of deploying malaria interventions by packages seems to be effectively targeting high burden areas with a wide range of interventions. However, not all districts showed the same level of performance, indicating that efficiency gains are still possible.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Prevención Primaria
/
Análisis Costo-Beneficio
/
Toma de Decisiones
/
Asignación de Recursos
/
Malaria
Tipo de estudio:
Evaluation_studies
/
Guideline
/
Health_economic_evaluation
/
Observational_studies
Límite:
Humans
País/Región como asunto:
Africa
Idioma:
En
Año:
2018
Tipo del documento:
Article