title: Costs and cost-effectiveness of a large-scale mass testing and treatment intervention for malaria in Southern Province, Zambia.
abstract: BACKGROUND
  A cluster, randomized, control trial of three dry-season rounds of a mass testing and treatment intervention (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in four districts in Southern Province, Zambia.
  
  
  METHODS
  Data were collected on the costs and logistics of the intervention and paired with effectiveness estimated from a community randomized control trial for the purpose of conducting a provider perspective cost-effectiveness analysis of MTAT vs no MTAT (Standard of Care).
  
  
  RESULTS
  Dry-season MTAT in this setting did not reduce malaria transmission sufficiently to permit transition to a case-investigation strategy to then pursue malaria elimination, however, the intervention did substantially reduce malaria illness and was a highly cost-effective intervention for malaria burden reduction in this moderate transmission area. The cost per RDT administered was estimated to be USD4.39 (range: USD1.62-13.96) while the cost per AL treatment administered was estimated to be USD34.74 (range: USD3.87-3,835). The net cost per disability adjusted life year averted (incremental cost-effectiveness ratio) was estimated to be USD804.
  
  
  CONCLUSIONS
  The intervention appears to be highly cost-effective relative to World Health Organization thresholds for malaria burden reduction in Zambia as compared to no MTAT. However, it was estimated that population-wide mass drug administration is likely to be more cost-effective for burden reduction and for transmission reduction compared to MTAT.
authors.affiliation: Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia. ksilumbe@path.org.
authors.forename: Kafula
authors.initials: K
authors.lastname: Silumbe
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. jyukich@tulane.edu.
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Yukich
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia. bossbusk@gmail.com.
authors.forename: Busiku
authors.initials: B
authors.lastname: Hamainza
authors.affiliation: Malaria Elimination Initiative, University of California San Francisco, San Francisco, USA. Adam.Bennett@ucsf.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia. dearle@path.org.
authors.forename: Duncan
authors.initials: D
authors.lastname: Earle
authors.affiliation: National Malaria Control Centre, Lusaka, Zambia. mkamuliwo@yahoo.co.uk.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.affiliation: Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia. rsteketee@path.org.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Steketee
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. teisele@tulane.edu.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
authors.affiliation: Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia. jmiller@path.org.
authors.forename: John M
authors.initials: JM
authors.lastname: Miller
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005449:Fluorenes / Q000627:therapeutic use*; D008288:Malaria / Q000188:drug therapy*; D008403:Mass Screening / Q000191:economics*; D015024:Zambia
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes