Scaling up malaria intervention “packages” in Senegal: using cost effectiveness data for improving allocative efficiency and programmatic decision-making

Faye, Sophie; Cico, Altea; Guèye, Alioune Badara; Baruwa, Elaine; Johns, Benjamin; Ndiop, Médoune; Alilio, Martin

doi:10.1186/s12936-018-2305-6

Cited by 12 publications

(16 citation statements)

References 22 publications

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“…Nonetheless, the overall results presented here are in line with a recent study in Senegal which similarly found reductions in incidence greatest in areas that received both IRS and SMC (52% reduction) compared to areas that received IRS (38% reduction) or SMC (32% reduction) alone [27] and recent modeling studies that indicate a high probability of strong synergies between complementary IRS and population-based drug interventions such as mass drug administration [25,26].…”

Section: Discussionsupporting

confidence: 91%

“…Developing this evidence base is a challenge, however, as the most robust methods for generating evidence (e.g., cluster randomized trials) are often unrealistic-the time, resources, and expertise required, and limited space available, are prohibitive. Observational/ecological studies can help address these challenges by allowing the geographical and temporal linking of malaria intervention coverage data, ecological and environmental data, and data from routine surveillance activities in order to provide insight into how trends in malaria incidence change in response to various interventions or packages of interventions [11,27]. Observational research questions are also adaptable to the unique malaria control landscape that exists in each country, taking advantage of 'natural experiments' that result from programme implementations.…”

Section: Introductionmentioning

confidence: 99%

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Combining next-generation indoor residual spraying and drug-based malaria control strategies: observational evidence of a combined effect in Mali

Wagman

Cissé

Kone

et al. 2020

Malar J

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Background: Ségou Region in central Mali is an area of high malaria burden with seasonal transmission. The region reports high access to and use of long-lasting insecticidal nets (LLINs), though the principal vector, Anopheles gambiae, is resistant to pyrethroids. From 2011 until 2016, several high-burden districts of Ségou also received indoor residual spraying (IRS), though in 2014 concerns about pyrethroid resistance prompted a shift in IRS products to a micro-encapsulated formulation of the organophosphate insecticide pirimiphos-methyl. Also in 2014, the region expanded a pilot programme to provide seasonal malaria chemoprevention (SMC) to children aged 3-59 months in two districts. The timing of these decisions presented an opportunity to estimate the impact of both interventions, deployed individually and in combination, using quality-assured passive surveillance data. Methods: A non-randomized, quasi-experimental time series approach was used to analyse monthly trends in malaria case incidence at the district level. Districts were stratified by intervention status: an SMC district, an IRS district, an IRS + SMC district, and control districts that received neither IRS nor SMC in 2014. The numbers of positive rapid diagnostic test (RDT +) results reported at community health facilities were aggregated and epidemiological curves showing the incidence of RDT-confirmed malaria cases per 10,000 person-months were plotted for the total all-ages and for the under 5 year old (u5) population. The cumulative incidence of RDT + malaria cases observed from September 2014 to February 2015 was calculated in each intervention district and compared to the cumulative incidence reported from the same period in the control districts. Results: Cumulative peak-transmission all-ages incidence was lower in each of the intervention districts compared to the control districts: 16% lower in the SMC district; 28% lower in the IRS district; and 39% lower in the IRS + SMC district. The same trends were observed in the u5 population: incidence was 15% lower with SMC, 48% lower with IRS, and 53% lower with IRS + SMC. The SMC-only intervention had a more moderate effect on incidence reduction initially, which increased over time. The IRS-only intervention had a rapid, comparatively large impact initially that waned over time. The impact of the combined interventions was both rapid and longer lasting.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Combining next-generation indoor residual spraying and drug-based malaria control strategies: observational evidence of a combined effect in Mali

Wagman

Cissé

Kone

et al. 2020

Malar J

View full text Add to dashboard Cite

show abstract

“…In addition, the predicted health benefits are comparable with current estimates of other interventions, such as the DALYS averted by the use of HIV protease inhibitors to prevent recurrent malaria incidence in HIV infected children [5,6] and prevention campaigns [54]. With respect to intervention costs, although higher costs per person unsurprisingly reduced the number of countries where a severe malaria intervention is cost-effective, our estimates of the ICER are comparable to various scale-up programs [55], and the effects of media on promoting life-saving practices [56].…”

Section: Discussionsupporting

confidence: 57%

Advocating an attack against severe malaria: a cost-effectiveness analysis

Greenhalgh

Chandwani

2020

BMC Public Health

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Background: A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. Methods: Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. Results: Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2-to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very costeffective in 25 countries. Conclusion: Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

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“…In addition, the predicted health benefits are comparable with current estimates of other interventions, such as the DALYS averted by the use of HIV protease inhibitors to prevent recurrent malaria incidence in HIV infected children [5,6] and prevention campaigns [42]. With respect to intervention costs, although higher costs per person unsurprisingly reduced the number of countries where a severe malaria intervention is cost-effective, our estimates of the ICER are comparable to various scale-up programs [43], and the effects of media on promoting life-saving practices [44].…”

Section: Discussionsupporting

confidence: 57%

Advocating an attack against severe malaria: a cost-effectiveness analysis

Greenhalgh

Chandwani

2019

Preprint

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Background Recently a study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective.Methods Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings.Results Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries.Conclusion Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

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Scaling up malaria intervention “packages” in Senegal: using cost effectiveness data for improving allocative efficiency and programmatic decision-making

Cited by 12 publications

References 22 publications

Combining next-generation indoor residual spraying and drug-based malaria control strategies: observational evidence of a combined effect in Mali

Combining next-generation indoor residual spraying and drug-based malaria control strategies: observational evidence of a combined effect in Mali

Advocating an attack against severe malaria: a cost-effectiveness analysis

Advocating an attack against severe malaria: a cost-effectiveness analysis

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