title: Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
abstract: BACKGROUND
  To evaluate the cost-effectiveness of the first nationwide delivery of long-lasting insecticide-treated nets (LLITNs) as part of the 2004 measles vaccination campaign in Togo to all children between nine months and five years.
  
  
  METHODS
  An incremental approach was used to calculate the economic costs and effects from a provider perspective. Effectiveness was estimated in terms of malaria cases averted, deaths averted and Disability-Adjusted Life Years (DALYs) averted. Malaria cases were modelled using regional estimates. Programme and treatment costs were derived through reviews of financial records and interviews with key stakeholders. Uncertain variables were subjected to a univariate sensitivity analysis.
  
  
  RESULTS
  Assuming equal attribution of shared costs between the LLITN distribution and the measles vaccination, the net costs per LLITN distributed were 4.41 USD when saved treatment costs were taken into account. Assuming a constant utilization of LLITNs by the target group over three years, 1.2 million cases could be prevented at a net cost per case averted of 3.26 USD. The net costs were 635 USD per death averted and 16.39 USD per DALY averted, respectively.
  
  
  CONCLUSIONS
  The costs per case, death and DALY averted are well within commonly agreed benchmarks set by other malaria prevention studies. Varying transmission levels are shown to have a significant impact on cost-effectiveness ratios. Results also suggest that substantial efficiency gains may be derived from the joint delivery of vaccination campaigns and malaria interventions.
authors.affiliation: Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, UK. Dirk.Mueller@lshtm.ac.uk
authors.forename: Dirk H
authors.initials: DH
authors.lastname: Mueller
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
authors.forename: Dankom
authors.initials: D
authors.lastname: Bakusa
authors.forename: Kodjo
authors.initials: K
authors.lastname: Morgah
authors.forename: Aboudou
authors.initials: A
authors.lastname: Daré
authors.forename: Potougnima
authors.initials: P
authors.lastname: Tchamdja
mesh_terms: D001512:Bedding and Linens / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D015994:Incidence; D007306:Insecticides / Q000008:administration & dosage / Q000191:economics*; D008288:Malaria / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D008457:Measles / Q000517:prevention & control; D009032:Mosquito Control / Q000191:economics* / Q000379:methods; D014037:Togo
chemical_list: D007306:Insecticides