title: A framework for evaluating the costs of malaria elimination interventions: an application to reactive case detection in Southern Province of Zambia, 2014.
abstract: This paper summarizes a framework for evaluating the costs of malaria elimination interventions and applies this approach to one key component of the elimination strategy-reactive case detection (RCD)-implemented through 173 health facilities across 10 districts in Southern Province of Zambia during 2014.
  
  
  
  The primary unit of analysis is the health facility catchment area (HFCA). A five-step approach was followed to estimate implementation costs: organize preliminary information; estimate basic unit costs; estimate activity unit costs; estimate and organize final unit cost database; and create the final costing database (one row of data per HFCA). By working through a specific application, the overall logic of the analysis and details of each step are presented. An electronic annex also provides all details of the analysis. Because population varies substantially across HFCAs, all results are reported per 1000 population in HFCAs.
  
  
  
  During 2014, 38.9 households per HFCA were visited for RCD services; 166.8 individuals were tested and 32.3 tested positive and were treated. The mean annual cost per HFCA was $1177 (median = $923, IQR $651-$1417). Variation in costs was driven by the number of CHWs and passive cases detected. CHW-related costs and data review meetings accounted for the largest share of costs. Rapid diagnostic tests and drugs accounted for less than 10 % of total costs.
  
  
  
  The framework presented here follows standard methods in applied costing of public health interventions (combining ingredients- and activity-based costing approaches into one final cost analysis). Through an application to a specific programme implemented in Zambia in 2014, the details of how to apply such methods to an actual programme are presented. Such details are not typically presented in existing costing analyses but are required for applied analysts working with national malaria control programmes and other organizations to complete such analyses as part of routine programme implementation. Obtaining data and information for implementing the approach remains complicated, in part because analysts from one organization may not have easy access to information from another organization. This basic approach is transparent and easily applied to other malaria elimination interventions being implemented in sub-Saharan Africa and elsewhere.
authors: Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 80211, USA. blarson@bu.edu.
authors: Bruce A
authors: BA
authors: Larson
authors: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia.
authors: Thandiwe
authors: T
authors: Ngoma
authors: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia.
authors: Kafula
authors: K
authors: Silumbe
authors: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia.
authors: Marie-Reine I
authors: MR
authors: Rutagwera
authors: Ministry of Health, National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, P.O. Box 32509, Lusaka, Zambia.
authors: Busiku
authors: B
authors: Hamainza
authors: Akros, Cresta Golfview Grounds, Great East Road, Unit 5, Lusaka, Zambia.|University of Montana School of Public and Community Health Sciences, Missoula, MT, USA.
authors: Anna M
authors: AM
authors: Winters
authors: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia.
authors: John M
authors: JM
authors: Miller
authors: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
authors: Callie A
authors: CA
authors: Scott
mesh_terms: D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods; D060740:Disease Eradication / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D015024:Zambia
keywords: Community case management; Cost; Elimination; Malaria; Reactive case detection; Zambia