title: The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi.
abstract: BACKGROUND
  Insecticide-treated nets (ITNs) are a proven intervention to reduce the burden of malaria, yet there remains a debate as to the best method of ensuring they are universally utilized. This study is a cost-effectiveness analysis of an intervention in Malawi that started in 1998, in Blantyre district, before expanding nationwide. Over the 5-year period, 1.5 million ITNs were sold.
  
  
  METHODS
  The costs were calculated retrospectively through analysis of expenditure data. Costs and effects were measured as cost per treated-net year (cost/TNY) and cost per net distributed.
  
  
  RESULTS
  The mean cost/TNY was calculated at $4.41, and the mean cost/ITN distributed at $2.63. It also shows evidence of economies of scale, with the cost/TNY falling from $7.69 in year one (72,196 ITN) to $3.44 in year five (720,577 ITN). Cost/ITN distributed dropped from $5.04 to $1.92.
  
  
  CONCLUSIONS
  Combining targeting and social marketing has the potential of being both cost-effective and capable of achieving high levels of coverage, and it is possible that increasing returns to scale can be achieved.
authors.affiliation: MRC Laboratories, PO Box 273, Banjul, The Gambia. wstevens@mrc.gm
authors.forename: Warren
authors.initials: W
authors.lastname: Stevens
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
authors.forename: Juan
authors.initials: J
authors.lastname: Ortiz
authors.forename: Desmond
authors.initials: D
authors.lastname: Chavasse
mesh_terms: D000818:Animals; D001512:Bedding and Linens / Q000191:economics*; D003362:Cost-Benefit Analysis; D006078:Government Programs / Q000191:economics*; D006801:Humans; D007306:Insecticides / Q000008:administration & dosage / Q000191:economics; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008295:Malawi; D009032:Mosquito Control / Q000191:economics* / Q000379:methods; D015397:Program Evaluation; D012189:Retrospective Studies
chemical_list: D007306:Insecticides