Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis
Abstract Background The entire population of Mozambique is at risk for malaria, which remains one of the leading causes of death. The 2017–2022 National Malaria Strategic Plan focuses on reducing malaria morbidity and mortality in high- and low-transmission areas. This study aimed to estimate the co...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12936-022-04354-9 |
| _version_ | 1828197868281790464 |
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| author | Anton L. V. Avanceña Angie Miller Neide Canana Janeth Dula Abuchahama Saifodine Baltazar Cadrinho Elisa M. Maffioli |
| author_facet | Anton L. V. Avanceña Angie Miller Neide Canana Janeth Dula Abuchahama Saifodine Baltazar Cadrinho Elisa M. Maffioli |
| author_sort | Anton L. V. Avanceña |
| collection | DOAJ |
| description | Abstract Background The entire population of Mozambique is at risk for malaria, which remains one of the leading causes of death. The 2017–2022 National Malaria Strategic Plan focuses on reducing malaria morbidity and mortality in high- and low-transmission areas. This study aimed to estimate the costs and health benefits of six variations of the World Health Organization’s “test-and-treat” strategy among children under five. Methods A decision tree model was developed that estimates the costs and health outcomes for children under five. Data on probabilities, costs, weights for disability-adjusted life years (DALYs), and quality-adjusted life years (QALYs) were based on peer-reviewed, grey literature, and primary data analysis of the 2018 Malaria Indicator Survey. Six scenarios were compared to the status quo and calculated the incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, DALY averted, and life saved. Deterministic and probabilistic sensitivity analyses were conducted to understand the effect of parameter uncertainty on the findings. Results In the base case, reaching the target of 100% testing with rapid diagnostic tests (RDTs; Scenario 1) is more cost-effective than improving the testing rate alone by 10% (Scenario 2). Achieving a 100% (Scenario 3) or a 10% increase in treatment rate (Scenario 4) have ICERs that are lower than Scenarios 1 and 2. Both Scenarios 5 and 6, which represent combinations of Scenarios 1–4, have lower ICERs than their constituent strategies on their own, which suggests that improvements in treatment are more cost-effective than improvements in testing alone. These results held when DALYs averted or lives saved were used as health outcomes. Deterministic and probabilistic sensitivity analyses revealed that the cost-effectiveness of Scenarios 1–6 are subject sensitive to parameter uncertainty, though Scenarios 4 and 5 are the optimal choice when DALYs averted or QALYs gained were used as the measure of health outcomes across all cost-effectiveness thresholds. Conclusions Improving testing rates alone among children at risk for malaria has the potential to improve health but may not be the most efficient use of limited resources. Instead, small or large improvements in treatment, whether alone or in conjunction with improvements in testing, are the most cost-effective strategies for children under five in Mozambique. |
| first_indexed | 2024-04-12T10:27:57Z |
| format | Article |
| id | doaj.art-34861b95c2fb4317b8b3e53518d4d8fb |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-04-12T10:27:57Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-34861b95c2fb4317b8b3e53518d4d8fb2022-12-22T03:36:56ZengBMCMalaria Journal1475-28752022-11-0121111010.1186/s12936-022-04354-9Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysisAnton L. V. Avanceña0Angie Miller1Neide Canana2Janeth Dula3Abuchahama Saifodine4Baltazar Cadrinho5Elisa M. Maffioli6Department of Health Management and Policy, School of Public Health, University of MichiganDepartment of Health Management and Policy, School of Public Health, University of MichiganMalaria ConsortiumHealth Policy and Systems Programme, Instituto Nacional de SaudeUnited States President’s Malaria Initiative, USAIDNational Malaria Control Programme, Ministry of HealthDepartment of Health Management and Policy, School of Public Health, University of MichiganAbstract Background The entire population of Mozambique is at risk for malaria, which remains one of the leading causes of death. The 2017–2022 National Malaria Strategic Plan focuses on reducing malaria morbidity and mortality in high- and low-transmission areas. This study aimed to estimate the costs and health benefits of six variations of the World Health Organization’s “test-and-treat” strategy among children under five. Methods A decision tree model was developed that estimates the costs and health outcomes for children under five. Data on probabilities, costs, weights for disability-adjusted life years (DALYs), and quality-adjusted life years (QALYs) were based on peer-reviewed, grey literature, and primary data analysis of the 2018 Malaria Indicator Survey. Six scenarios were compared to the status quo and calculated the incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, DALY averted, and life saved. Deterministic and probabilistic sensitivity analyses were conducted to understand the effect of parameter uncertainty on the findings. Results In the base case, reaching the target of 100% testing with rapid diagnostic tests (RDTs; Scenario 1) is more cost-effective than improving the testing rate alone by 10% (Scenario 2). Achieving a 100% (Scenario 3) or a 10% increase in treatment rate (Scenario 4) have ICERs that are lower than Scenarios 1 and 2. Both Scenarios 5 and 6, which represent combinations of Scenarios 1–4, have lower ICERs than their constituent strategies on their own, which suggests that improvements in treatment are more cost-effective than improvements in testing alone. These results held when DALYs averted or lives saved were used as health outcomes. Deterministic and probabilistic sensitivity analyses revealed that the cost-effectiveness of Scenarios 1–6 are subject sensitive to parameter uncertainty, though Scenarios 4 and 5 are the optimal choice when DALYs averted or QALYs gained were used as the measure of health outcomes across all cost-effectiveness thresholds. Conclusions Improving testing rates alone among children at risk for malaria has the potential to improve health but may not be the most efficient use of limited resources. Instead, small or large improvements in treatment, whether alone or in conjunction with improvements in testing, are the most cost-effective strategies for children under five in Mozambique.https://doi.org/10.1186/s12936-022-04354-9Cost-effectivenessMalariaTestingTreatmentRapid diagnostic testingArtemisinin combination therapy |
| spellingShingle | Anton L. V. Avanceña Angie Miller Neide Canana Janeth Dula Abuchahama Saifodine Baltazar Cadrinho Elisa M. Maffioli Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis Malaria Journal Cost-effectiveness Malaria Testing Treatment Rapid diagnostic testing Artemisinin combination therapy |
| title | Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis |
| title_full | Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis |
| title_fullStr | Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis |
| title_full_unstemmed | Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis |
| title_short | Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis |
| title_sort | achieving malaria testing and treatment targets for children under five in mozambique a cost effectiveness analysis |
| topic | Cost-effectiveness Malaria Testing Treatment Rapid diagnostic testing Artemisinin combination therapy |
| url | https://doi.org/10.1186/s12936-022-04354-9 |
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