bed nets are integral to national malaria programmes
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Bed nets are integral to national malaria programmes. WHO recommends using long-lasting insecticide-treated bed nets (LLINs). Few comparative studies of bed net distribution, and fewer economic evaluations of LLIN distribution. - PowerPoint PPT PresentationTRANSCRIPT
Cost and cost effectiveness of long-lasting insecticide-treated bed nets: A model-based
analysisA-M Pulkki-Brännström1§, C Wolff2, N Brännström3 and J Skordis-Worrall1
1UCL Centre for International Health and Development, University College London, UK, 2Stockholm School of Economics, Sweden, 3University of
Helsinki, Finland
• Bed nets are integral to national
malaria programmes.
• WHO recommends using long-lasting
insecticide-treated bed nets (LLINs).
• Few comparative studies of bed net
distribution, and fewer economic
evaluations of LLIN distribution
• Need to better understand
determinants of cost effectiveness
of different bed net types
• When and why are LLINs preferred
to conventional insecticide-treated
nets?
• Which lifespan should be selected
for LLIN?
1. Background
Explore impact of parameters on cost effectiveness in an Excel model.Choice Variables:
• Coverage (no of nets to population size),
usage rate, net type, price, lifespan,
delivery method, replenishment need &
delivery, procurement costs, geographic
area.
Outcome Variables:
• No. of people protected, cost per person
protected, U5 deaths averted, cost per U5
death averted, DALYs averted.
2. Methods
10-year period considered
Regular distribution rounds:
• procurement and distribution costs
• choice of distribution method:
1. Free distribution in campaign (USD
2.7)
2. Free distribution through routine
services (USD 2.65/USD 1.4)
3. Subsidised sales and social
marketing (USD 3.9)
Annual replenishment rounds (keeping coverage constant, smaller number of nets distributed, every year until next main distribution round)
3 Scenarios of replenishment need: 1. Annual loss rate constant proportion
of nets distributed initially.
2. Annual loss rate constant proportion of nets of nets still in use
3. Loss rate increases until 50% of initially distributed nets remain
• Large-scale programme
with high coverage & use
• ITNs distributed through
existing health services.
• ITNs regularly retreated at
low cost
• Parameters from literature
review where possible
• Sensitivity analysis
3. The Model: Variable Benchmark case Sensitivity analysis Sources
ITN/LLIN effectiveness 5.5 deaths averted / 1000 under-5s protected pa.
- Lengeler 2004
Coverage 1m nets, 4m people20% under 5
- comparable to WMR 2010
Usage rate (Year 1) 50% overall70% under-5s
30% total, 50% under-5s30% both
DHS surveys and various studies
Purchase price USD 4USD 3-7 (LLINs)USD 1-5 (ITNs)
Kolaczinski 2010and assumptions
Lifespan 3 years3 - 5 years (LLINs)1 - 4 years (ITNs)
WHOPES 2009, Erlanger 2004
Delivery cost and method
USD 1.4 per net; Free integrated dbn (>0.75m)
USD 3.86 per netSubs. sales & social marketing
12 sources, 17 programmes
Insecticide retreatment 75% treated annuallyUSD 0.64 per net
50% annually / 75% biannuallyUSD 1.28 per net
9 sources
Replenishment need NoneIncreasing/constant/decreasing proportion lost per annum
A. Kilian (increasing loss)
Replenishment delivery cost
- USD 1.4 or USD 3.86 per net See Table 24. Findings 5. Conclusions
• LLINs more cost effective than ITNs with
same lifespan - unless US$ 1.5 more
expensive.
• For each year of a longer lifespan a bed
net can be US$ 1 more expensive, while
still being more cost effective.
• Replenishing nets raises protective
effectiveness by 5-14% .
– Replenishment costs: US$ 17-25 per person per
annum US$ 1080-1610 per under-5 death
averted.
• Limitations:1. Treatment costs, household costs of
malaria: No robust estimates for different geographic areas available.
2. Effectiveness of untreated nets: Not enough available data
• Program planners should be willing to pay a premium for nets which have a longer lifespan up to a price threshold.
• Replenishment (incrementally) cost effective if planners willing to spend US$ 1610 per U5 death averted.