OBJECTIVES: The Against Malaria Foundation (AMF) provides funding for long-lasting insecticide net (LLIN) distributions in developing countries. The objective of this study was to estimate the cost-effectiveness of LLINs compared to untreated nets (UTNs) and no nets (NN) for the prevention of malaria in rural and urban malarious areas.

METHODS: A Markov model was developed to estimate the cost per quality-adjusted life-year (QALY) gained for LLINs versus UTNs and NNs. The model considered three populations; children aged less than 5 years old, children aged between 5 and 18 years old, and adults and children of any age. Model health states included: alive and healthy; alive with malaria; and dead. Transition probabilities, costs and utilities were based on published literature. Cost categories included were the acquisition and distribution of nets, and health clinic visits.

RESULTS: Compared to NNs, LLINs were associated with an incremental cost-effectiveness ratio (ICER) of £795, £915 and £277 per QALY gained for children aged less than 5 years, children aged between 5 and 18 years old, and adults and children of any age, respectively. Compared to UTNs, LLINs were associated with an ICER of £875, £969 and £230 per QALY gained for children aged less than 5 years, children aged between 5 and 18 years old, and adults and children of any age, respectively. Results were robust to deterministic and probabilistic sensitivity analyses.

CONCLUSIONS: When considering cost-effectiveness thresholds used in the healthcare industry, LLINs can be considered cost-effective intervention compared to UTNs and NNs across all age groups in malarious areas. GiveWell, a non-profit organisation dedicated to finding outstanding giving opportunities, recommends the AMF as one of their top-rated charities. These results support GiveWell’s recommendation and demonstrate that the AMF can be considered as an outstanding giving opportunity for donors.