COST-EFFECTIVENESS OF MALARIA PREVENTION STRATEGIES IN CHILDREN UNDER FIVE IN HIGH-ENDEMIC SETTINGS
Author(s)
Katsiaryna Bashlakova, MD, PhD, Marianna Zarro, MD, Giuliana Federico, MSc, Annalisa Rosso, MD, PhD, Corrado De Vito, MD, PhD.
Sapienza University of Rome, Rome, Italy.
Sapienza University of Rome, Rome, Italy.
OBJECTIVES: Optimising malaria prevention in resource-constrained, high-endemic areas remains a global health priority. Evidence on the cost-effectiveness of combined prevention strategies remains limited. This study assesses these strategies to inform health policy decisions.
METHODS: Two decision tree models were developed from the healthcare system perspective. The first model, based on Burkina Faso surveillance data (2010-2024), compared five strategies: vaccine+chemoprophylaxis+insecticide-treated nets (VAC+SMC+ITN), SMC+ITN, SMC, ITNs, and no intervention. Outcomes included outpatient malaria, hospitalization, and death. The second model used RCT data from West Africa to compare vaccine, SMC, and SMC+vaccine, incorporating malaria complications. Expected costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. One-way sensitivity analysis (OWSA) assessed variation in malaria probability, probabilistic sensitivity analysis (PSA) explored all parameters’ uncertainty.
RESULTS: In the first model, SMC showed the lowest ICER (21.9US$/DALY averted), with expected costs of 16.58$ and 0.027 DALYs. VAC+SMC+ITN produced the greatest health benefit (0.085DALYs averted) but at the highest cost (23.06$), with an ICER of 97.4$/DALY averted. SMC+ITN showed an ICER of 50.2$/DALY averted, while ITNs were dominated (ICER -1038$/DALY). In the second model, SMC+vaccine achieved the lowest DALY burden (0.030) and an ICER of 15.7$/DALY averted vs SMC, whereas the vaccine was less effective despite lower costs. OWSA demonstrated highly stable ICER estimates for VAC+SMC+ITN (97.43-97.44$/DALY). PSA showed mean ICERs of 191.4$/DALY (IC 95%: −1540.86 to 1596.36) for VAC+SMC+ITN and 354.8$/DALY (IC 95%: −733.68 to 837.02) for SMC. At a willingness-to-pay threshold of 750$/DALY, probabilities of cost-effectiveness were 89.3% for SMC, 85.5% for SMC+ITN, and 85.2% for VAC+SMC+ITN.
CONCLUSIONS: The addition of vaccination to existing preventive measures provides the greatest health gains and remains cost-effective, despite higher costs. SMC is a pragmatic alternative where resources are limited. These findings support prioritising integrated prevention strategies to maximise population health impact in malaria-endemic regions.
METHODS: Two decision tree models were developed from the healthcare system perspective. The first model, based on Burkina Faso surveillance data (2010-2024), compared five strategies: vaccine+chemoprophylaxis+insecticide-treated nets (VAC+SMC+ITN), SMC+ITN, SMC, ITNs, and no intervention. Outcomes included outpatient malaria, hospitalization, and death. The second model used RCT data from West Africa to compare vaccine, SMC, and SMC+vaccine, incorporating malaria complications. Expected costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. One-way sensitivity analysis (OWSA) assessed variation in malaria probability, probabilistic sensitivity analysis (PSA) explored all parameters’ uncertainty.
RESULTS: In the first model, SMC showed the lowest ICER (21.9US$/DALY averted), with expected costs of 16.58$ and 0.027 DALYs. VAC+SMC+ITN produced the greatest health benefit (0.085DALYs averted) but at the highest cost (23.06$), with an ICER of 97.4$/DALY averted. SMC+ITN showed an ICER of 50.2$/DALY averted, while ITNs were dominated (ICER -1038$/DALY). In the second model, SMC+vaccine achieved the lowest DALY burden (0.030) and an ICER of 15.7$/DALY averted vs SMC, whereas the vaccine was less effective despite lower costs. OWSA demonstrated highly stable ICER estimates for VAC+SMC+ITN (97.43-97.44$/DALY). PSA showed mean ICERs of 191.4$/DALY (IC 95%: −1540.86 to 1596.36) for VAC+SMC+ITN and 354.8$/DALY (IC 95%: −733.68 to 837.02) for SMC. At a willingness-to-pay threshold of 750$/DALY, probabilities of cost-effectiveness were 89.3% for SMC, 85.5% for SMC+ITN, and 85.2% for VAC+SMC+ITN.
CONCLUSIONS: The addition of vaccination to existing preventive measures provides the greatest health gains and remains cost-effective, despite higher costs. SMC is a pragmatic alternative where resources are limited. These findings support prioritising integrated prevention strategies to maximise population health impact in malaria-endemic regions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE752
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Disease
Vaccines