# name
Moving towards malaria elimination in southern Mozambique: Cost
and cost-effectiveness of mass drug administration combined with
intensified malaria control.

# metadata.dc.description.abstract[].value
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.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Moving towards malaria elimination in southern Mozambique: Cost
and cost-effectiveness of mass drug administration combined with
intensified malaria control.