Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya.
BACKGROUND
Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT) as delivered by teachers in schools in western Kenya.


METHODS
Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly). Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness.


RESULTS
The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child) whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year). The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively.


CONCLUSIONS
This study provides the first evidence that IPT administered by teachers is a cost-effective school-based malaria intervention and merits investigation in other settings.
Temperley
Matilda
M
London School of Hygiene and Tropical Medicine, London, UK. matildatemperley@googlemail.com
Mueller
Dirk H
DH
Njagi
J Kiambo
JK
Akhwale
Willis
W
Clarke
Siân E
SE
Jukes
Matthew C H
MC
Estambale
Benson B A
BB
Brooker
Simon
S
D000740:Anemia / Q000517:prevention & control; D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D003140:Communicable Disease Control / Q000191:economics*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000191:economics* / Q000517:prevention & control*; D018512:Parasitemia / Q000517:prevention & control; D011153:Population; D011739:Pyrimethamine / Q000191:economics* / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000191:economics* / Q000627:therapeutic use*
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine