Costs and consequences of large-scale vector control for malaria.
BACKGROUND
Five large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology.


METHODS
Costs were measured locally or derived from existing studies and focused on the provider perspective, but included the direct costs of net purchases by users, and are reported in 2005 USD. Effectiveness was estimated by combining programme outputs with standard impact indicators.


RESULTS
Conventional ITNs: The cost per treated net-year of protection ranged from USD 1.21 in Eritrea to USD 6.05 in Senegal. The cost per child death averted ranged from USD 438 to USD 2,199 when targeting to children was successful.Long-lasting insecticidal nets (LLIN) of five years duration: The cost per treated-net year of protection ranged from USD 1.38 in Eritrea to USD 1.90 in Togo. The cost per child death averted ranged from USD 502 to USD 692.IRS: The costs per person-year of protection for all ages were USD 3.27 in KwaZulu Natal and USD 3.90 in Mozambique. If only children under five years of age were included in the denominator the cost per person-year of protection was higher: USD 23.96 and USD 21.63. As a result, the cost per child death averted was higher than for ITNs: USD 3,933-4,357.


CONCLUSIONS
Both ITNs and IRS are highly cost-effective vector control strategies. Integrated ITN free distribution campaigns appeared to be the most efficient way to rapidly increase ITN coverage. Other approaches were as or more cost-effective, and appeared better suited to "keep-up" coverage levels. ITNs are more cost-effective than IRS for highly endemic settings, especially if high ITN coverage can be achieved with some demographic targeting.
Yukich
Joshua O
JO
Department of Public Health and Epidemiology, Swiss Tropical Institute, PO Box, 4002 Basel, Switzerland. joshua.yukich@unibas.ch
Lengeler
Christian
C
Tediosi
Fabrizio
F
Brown
Nick
N
Mulligan
Jo-Ann
JA
Chavasse
Des
D
Stevens
Warren
W
Justino
John
J
Conteh
Lesong
L
Maharaj
Rajendra
R
Erskine
Marcy
M
Mueller
Dirk H
DH
Wiseman
Virginia
V
Ghebremeskel
Tewolde
T
Zerom
Mehari
M
Goodman
Catherine
C
McGuire
David
D
Urrutia
Juan Manuel
JM
Sakho
Fana
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Hanson
Kara
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Sharp
Brian
B
D000349:Africa / Q000453:epidemiology; D001512:Bedding and Linens / Q000191:economics; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D009032:Mosquito Control / Q000191:economics* / Q000379:methods*