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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/182966
Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control.
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BACKGROUND NlmCategory: BACKGROUND content: As new combinations of interventions aiming at interrupting malaria
transmission are under evaluation, understanding the associated
economic costs and benefits is critical for decision-making.
This study assessed the economic cost and cost-effectiveness of
the Magude project, a malaria elimination initiative implemented
in a district in southern Mozambique (i.e. Magude) between
August 2015-June 2018. This project piloted a combination of two
mass drug administration (MDA) rounds per year for two
consecutive years, annual rounds of universal indoor residual
spraying (IRS) and a strengthened surveillance and response
system on the back of universal long-lasting insecticide treated
net (LLIN) coverage and routine case management implemented by
the National Malaria Control Program (NMCP). Although local
transmission was not interrupted, the project achieved large
reductions in the burden of malaria in the target district. -
Label: METHODS NlmCategory: METHODS content: We collected weekly
economic data, estimated costs from the project implementer
perspective and assessed the incremental cost-effectiveness
ratio (ICER) associated with the Magude project as compared to
routine malaria control activities, the counterfactual. We
estimated disability-adjusted life years (DALYs) for malaria
cases and deaths and assessed the variation of the ICER over
time to capture the marginal costs and effectiveness associated
with subsequent phases of project implementation. We used
deterministic and probabilistic sensitivity analyses to account
for uncertainty and built an alternative scenario by assuming
the implementation of the interventions from a governmental
perspective. Economic costs are provided in constant US$2015. -
Label: RESULTS NlmCategory: RESULTS content: After three years,
the Magude project averted a total of 3,171 DALYs at an
incremental cost of $2.89 million and an average yearly cost of
$20.7 per targeted person. At an average cost of $19.4 per
person treated per MDA round, the social mobilization and
distribution of door-to-door MDA contributed to 53% of overall
resources employed, with personnel and logistics being the main
cost drivers. The ICER improved over time as a result of
decreasing costs and improved effectiveness. The overall ICER
was $987 (CI95% 968-1,006) per DALY averted, which is below the
standard cost-effectiveness (CE) threshold of $1,404/DALY
averted, three times the gross domestic product (GDP) per capita
of Mozambique, but above the threshold of interventions
considered highly cost-effective (one time the GDP per capita or
$468/DALY averted) and above the recently suggested thresholds
based on the health opportunity cost ($537 purchasing power
parity/ DALY averted). A significantly lower ICER was obtained
in the implementation scenario from a governmental perspective
($441/DALY averted). - Label: CONCLUSION NlmCategory:
CONCLUSIONS content: Despite the initial high costs and volume
of resources associated with its implementation, MDA in
combination with other existing malaria control interventions,
can be a cost-effective strategy to drastically reduce
transmission in areas of low to moderate transmission in
sub-Saharan Africa. However, further studies are needed to
understand the capacity of the health system and financial
affordability to scale up such strategies at regional or
national level.
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CIRERA, Laia, GALATAS, Beatriz, ALONSO, Sergi, PAAIJMANS, Krijn p., MAMUQUELE, Miler, MARTÍ SOLER, Helena, GUINOVART, Caterina, MUNGUAMBE, Humberto, LUIS, Fabião, NHANTUMBO, Hoticha, MONTAÑÀ LÓPEZ, Julia, BASSAT ORELLANA, Quique, CANDRINHO, Baltazar, RABINOVICH, Regina, MACETE, Eusebio víctor, AIDE, Pedro carlos paulino, ALONSO, Pedro, SAUTE, Francisco, SICURI, Elisa. Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control.. _PLoS ONE_. 2020. Vol. vol 15, núm. num 7. [consulta: 23 de gener de 2026]. ISSN: 1932-6203. [Disponible a: https://hdl.handle.net/2445/182966]