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Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review

Open AccessPublished:May 17, 2021DOI:https://doi.org/10.1016/j.jval.2021.01.013

      Abstract

      Objectives

      To systematically review the literature on the unit cost and cost-effectiveness of malaria control.

      Methods

      Ten databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider and household, or societal perspective were included.

      Results

      We identified 103 costing studies. The majority of studies focused on individual rather than combined interventions, notably insecticide-treated bed nets and treatment, and commonly took a provider perspective. A third of all studies took place in 3 countries. The median provider economic cost of protecting 1 person per year ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed with rapid diagnostic tests was $6.06 and per case treated $9.31 or $89.93 depending on clinical severity. Other interventions did not share enough similarities to be summarized. Cost drivers were rarely reported. Cost-effectiveness of malaria control was reiterated, but care in methodological and reporting standards is required to enhance data transferability.

      Conclusions

      Important information that can support resource allocation was reviewed. Given the variability in methods and reporting, global efforts to follow existing standards are required for the evidence to be most useful outside their study context, supplemented by guidance on options for transferring existing data across settings.

      Keywords

      Introduction

      No significant reduction in malaria burden has been recorded since 2015, and in some countries, the disease burden is on the rise.
      WHO
      World Malaria Report 2019.
      In 2018, 6 countries accounted for more than half of all malaria cases (Nigeria, the Democratic Republic of the Congo, Uganda, Côte d’Ivoire, Mozambique, and Niger), and children under 5 years of age represented two thirds of the 405 000 malaria-related deaths globally.
      WHO
      World Malaria Report 2019.
      The level of global investments in malaria is reported to be below the estimated resource needs to achieve progress targets.
      • Feachem R.G.A.
      • Chen I.
      • Akbari O.
      • et al.
      Malaria eradication within a generation: ambitious, achievable, and necessary.
      RBM Partnership
      Action and Investment to Defeat Malaria 2016-2030.
      WHO
      Global Technical Strategy for malaria 2016-2030.
      WHO
      Malaria Eradication: Benefits, Future Scenarios and Feasibility: Executive Summary.
      Under tight funding constraints, evidence on the unit cost and cost-effectiveness of malaria control interventions becomes ever more important, and how resources are allocated comes under increasing scrutiny. We update previous malaria control unit cost and cost-effectiveness reviews
      • Tediosi F.
      • Lengeler C.
      • Castro M.
      • et al.
      Malaria control (Chapter 13).
      • White M.T.
      • Conteh L.
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      • Ghani A.C.
      Costs and cost-effectiveness of malaria control interventions: a systematic review.
      • White M.T.
      • Yeung S.
      • Patouillard E.
      • Cibulskis R.
      Costs and cost-effectiveness of Plasmodium vivax control.
      • Eisele T.P.
      • Larsen D.A.
      • Walker N.
      • et al.
      Estimates of child deaths prevented from malaria prevention scale-up in Africa 2001-2010.
      • Wisniewski J.
      • Acosta A.
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      • Koenker H.
      • Yukich J.
      Systematic review and meta-analysis of the cost and cost-effectiveness of distributing insecticide-treated nets for the prevention of malaria.
      and widen the scope of evidence by adding new data and interventions with the aim to inform decision-making processes for national malaria control strategies.

      Methods

      Search Strategy and Selection Criteria

      We searched peer-reviewed studies from Medline, Embase, Econlit, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry, Cochrane Library, Web of Science, and the Latin American and Caribbean Health Sciences Literature and gray literature from GreyNet/OpenSIGLE, the Social Science Research Network, and the websites of the World Bank Group, the World Health Organization (WHO), the United States Agency for International Development, and Population Services International. Searches were restricted to studies published between January 1, 2005, and August 31, 2018. Before 2005, the set of malaria control interventions implemented by countries was relatively limited; some of these interventions are not recommended anymore, while others had very low coverage and have since been replaced by different commodities. Our project started in June 2018, and we stopped searches in September 2018. We used English search terms (see Appendix 1 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013) only but considered studies published in English, French, or Spanish. Reference lists of eligible studies were reviewed and topic experts consulted to identify additional articles for inclusion. Studies included had to contain primary cost data on 1 or more WHO-recommended malaria control interventions and take a provider, provider and household, or societal perspective. Excluded were studies that: (1) exclusively relied on mathematical modeling of cost data published by other studies; (2) took a household perspective only; (3) were found in poster presentation or conference abstract formats only; or (4) pertained to the health of short-term travelers from non-endemic to endemic countries. The study protocol was registered under Prospero, number CRD42018105625.

      Data Management and Analysis

      Titles and abstracts were imported into the Covidence systematic review online management tool. Three reviewers independently screened titles and abstracts, retrieved full texts of potentially relevant studies, and assessed study eligibility for inclusion; discrepancies were resolved by a fourth reviewer. Review team members extracted the data independently using a table developed following discussions with investigators from the Global Health Costing Consortium.
      • Vassall A.
      • Sweeney S.
      • Kahn J.
      • et al.
      Reference case for estimating the costs of global health services and interventions.
      Extracted data included: the characteristics of each eligible study (first author, publication year, country name, rural/urban or mixed study setting); details of the studied intervention (type, delivery strategy, and/or platform; population targeted; number of commodities distributed or area covered if applicable); the analytical methods (study perspective, including provider/household and provider or societal; financial or economic cost; unit cost output measure, cost-effectiveness health outcome measure where applicable); and the results (unit cost or cost-effectiveness estimate; breakdown of unit cost data by cost category, by resource input, and/or activity where available).
      When a study provided data for several years, only data from the most recent year were extracted. If unit cost data were not explicitly reported by studies, data on total cost and number of commodities delivered or individuals covered by an intervention were used. When the cost per treatment course was not reported by a study, we estimated it using cost per dose data reported by the study and WHO treatment recommendations to allow output cost comparability across studies. Malaria treatment at outpatient departments was considered uncomplicated malaria treatment, whereas health facility admissions were assumed to be severe cases. For graphical display, percentage unit cost category data were converted to absolute terms.
      Summary statistics were calculated by intervention, perspective, and unit cost output and/or cost-effectiveness health outcome measure when more than 3 data points were available. We present economic rather than financial data to better reflect resource use. All cost data were converted to constant USD 2018.
      US Inflation Calculator.
      Cost data in currencies other than US dollars were first converted from the local currency to US dollars using the exchange rate at the year of costing before being inflated to 2018 USD.
      Historical Currency Converter.

      Results

      The search yielded 16 985 records. Using Covidence, 6505 duplicates were removed. A further 9621 records were excluded by title or abstract; 859 full-text articles were read and 754 were excluded, of which 180 were duplicates previously unidentified by Covidence, and 576 studies did not meet our inclusion criteria. A total of 103 eligible studies were identified. This section summarizes key results across eligible studies before describing in more detail results by intervention type.

      Overview of Results

      Eligible studies concerned vector control interventions (n = 32, 31%), chemoprevention in special risk groups (n = 12, 12%), diagnostics (n = 18, 17%), treatment (n = 21, 20%), surveillance (n = 9, 9%), and combinations of 2 or more interventions (n = 11, 11%) (Fig. 1). The number of eligible studies peaked at 14 in 2014 and 2017 (see Appendix 2 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013). The eligible studies covered a total of 39 countries, with one third of the studies concerned with the unit cost and cost-effectiveness of malaria control in 3 sub-Saharan African countries only, including Tanzania (n = 22), Ghana (n = 13), and Zambia (n = 12) (Fig. 2). Fewer studies concerned other regions, including the Eastern Mediterranean region (n = 3), the Southeast Asia region (n = 3), the Western Pacific region (n = 5), and the region of the Americas (n = 4). Less than one fifth (18%) of the eligible studies took place in 1 of the 6 countries that together accounted for more than half of all malaria cases worldwide in 2018.
      WHO
      World Malaria Report 2019.
      When interpreting the geographical distribution and intervention type of studies, however, it is important to note that among the eligible studies were both multi-country (11%) and multi-intervention (11%) studies.
      Figure thumbnail gr2
      Figure 2Geographical distribution of eligible studies by intervention and study type.
      From a provider perspective, the median economic cost of protecting 1 person from malaria ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed was $6.06 with rapid diagnostic test (RDT) and $2.53 with microscopy, while it was per case treated $9.31 and $89.93 for uncomplicated and severe malaria, respectively. For surveillance and combinations of interventions, the types of activities and the range of unit cost output measures used in the eligible studies did not share enough similarities to be summarized.

      Vector Control

      Vector control interventions include measures against malaria-transmitting mosquitoes intended to limit mosquitoes’ ability to transmit the disease. Vector control eligible studies investigated the cost of the 2 core vector control interventions, including insecticide-treated nets (ITNs) (n = 26, 81%),
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      • Bonner K.
      • Mwita A.
      • McElroy P.D.
      • et al.
      Design, implementation and evaluation of a national campaign to distribute nine million free LLINs to children under five years of age in Tanzania.
      • De Allegri M.
      Comparative cost analysis of insecticide-treatment net delivery strategies: sales supported by social marketing and free distribution through antenatal care.
      • Grabowsky M.
      • Farrell N.
      • Hawley W.
      • et al.
      Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods.
      • Kolaczinski J.H.
      • Kolaczinski K.
      • Kyabayinze D.
      • et al.
      Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.
      • Morel C.M.
      • Thang N.D.
      • Erhart A.
      • et al.
      Cost-effectiveness of long-lasting insecticide-treated hammocks in preventing malaria in south-central Vietnam.
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      • Ntuku H.M.
      • Ruckstuhl L.
      • Julo-Réminiac J.-E.
      • et al.
      Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo.
      • Pemba D.F.
      • Bandason E.
      • Namangale J.
      Comparison of deltamethrin as indoor residual spray or on insecticide treated nets for mosquito control in Lake Chilwa.
      • Renggli S.
      • Mandike R.
      • Kramer K.
      • et al.
      Design, implementation and evaluation of a national campaign to deliver 18 million free long-lasting insecticidal nets to uncovered sleeping spaces in Tanzania.
      • Scates S J.Y.
      Mass Campaigns and Routine Distribution in Mali.

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(a).

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(b).

      • Sedlmayr R.
      • Fink G.
      • Miller J.M.
      • Earle D.
      • Steketee R.W.
      Health impact and cost-effectiveness of a private sector bed net distribution: experimental evidence from Zambia.
      • Smith Paintain L.
      • Awini E.
      • Addei S.
      • et al.
      Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.
      • Stevens W.
      • Wiseman V.
      • Ortiz J.
      • Chavasse D.
      The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi.
      WHO
      Costing of ZMCP ITN Program: Report of a Consultation.
      WHO
      Costing of Uganda ITN Activities: Report of a Consultation.
      WHO
      Costing of PSI-Kenya ITN Program: Report of a Consultation.
      • Wisniewski J
      • Yukich J
      Cost Analysis Series Routine Facility-Based Distrbution in Main Tanzania.
      • Yukich J.
      Ghana LLIN Continuous Distribution Cost Analysis.
      • Yukich J.
      Continuous Distribution – Zanzibar.

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      and/or indoor residual spraying (IRS) (n = 3, 9%)
      • Pemba D.F.
      • Bandason E.
      • Namangale J.
      Comparison of deltamethrin as indoor residual spray or on insecticide treated nets for mosquito control in Lake Chilwa.
      ,

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      ,
      • Cico A.
      • Johns B.
      • Abt Associates I.
      PMI IRS Country Programs: 2017 Comparative Cost Analysis.
      or larval source management (LSM) (n = 5, 16%),
      • Dambach P.
      • Schleicher M.
      • Stahl H.C.
      • et al.
      Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso.
      • Kusumawathie P.H.D.
      • Wickremasinghe A.R.
      • Karunaweera N.D.
      • Wijeyaratne M.J.S.
      Costs and effectiveness of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river basins below the major dams of Sri Lanka.
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      • Rahman R.
      • Lesser A.
      • Mboera L.
      • Kramer R.
      Cost of microbial larviciding for malaria control in rural Tanzania.
      • Worrall E.
      • Fillinger U.
      Large-scale use of mosquito larval source management for malaria control in Africa: a cost analysis.
      a supplementary vector intervention. Seven ITN,
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      ,
      • Morel C.M.
      • Thang N.D.
      • Erhart A.
      • et al.
      Cost-effectiveness of long-lasting insecticide-treated hammocks in preventing malaria in south-central Vietnam.
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      ,
      • Smith Paintain L.
      • Awini E.
      • Addei S.
      • et al.
      Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.
      ,

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      1 IRS,

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      and 1 LSM
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      studies were also cost-effectiveness studies.

      Insecticide-treated bed nets (ITN)

      ITN are either conventionally treated nets that rely on periodic retreatment of nets by dipping into an insecticide formulation or factory-treated, pyrethroid-only, long-lasting insecticide nets (LLINs) made of netting material with insecticide incorporated within or bound around the fibers. A net needs to retain its effective biological activity for 3 years of recommended use under field conditions to qualify as an LLIN. Most ITN studies considered pyrethroid-only long-lasting insecticide nets (LLIN),
      • Bonner K.
      • Mwita A.
      • McElroy P.D.
      • et al.
      Design, implementation and evaluation of a national campaign to distribute nine million free LLINs to children under five years of age in Tanzania.
      ,
      • De Allegri M.
      Comparative cost analysis of insecticide-treatment net delivery strategies: sales supported by social marketing and free distribution through antenatal care.
      ,
      • Kolaczinski J.H.
      • Kolaczinski K.
      • Kyabayinze D.
      • et al.
      Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.
      ,
      • Morel C.M.
      • Thang N.D.
      • Erhart A.
      • et al.
      Cost-effectiveness of long-lasting insecticide-treated hammocks in preventing malaria in south-central Vietnam.
      ,
      • Ntuku H.M.
      • Ruckstuhl L.
      • Julo-Réminiac J.-E.
      • et al.
      Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo.
      ,
      • Renggli S.
      • Mandike R.
      • Kramer K.
      • et al.
      Design, implementation and evaluation of a national campaign to deliver 18 million free long-lasting insecticidal nets to uncovered sleeping spaces in Tanzania.
      • Scates S J.Y.
      Mass Campaigns and Routine Distribution in Mali.

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(a).

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(b).

      • Sedlmayr R.
      • Fink G.
      • Miller J.M.
      • Earle D.
      • Steketee R.W.
      Health impact and cost-effectiveness of a private sector bed net distribution: experimental evidence from Zambia.
      • Smith Paintain L.
      • Awini E.
      • Addei S.
      • et al.
      Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.
      ,
      WHO
      Costing of ZMCP ITN Program: Report of a Consultation.
      WHO
      Costing of Uganda ITN Activities: Report of a Consultation.
      WHO
      Costing of PSI-Kenya ITN Program: Report of a Consultation.
      • Wisniewski J
      • Yukich J
      Cost Analysis Series Routine Facility-Based Distrbution in Main Tanzania.
      • Yukich J.
      Ghana LLIN Continuous Distribution Cost Analysis.
      • Yukich J.
      Continuous Distribution – Zanzibar.
      ,
      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      the most common type of ITN currently deployed, whereas others, published before 2009, examined ITN with pyrethroid insecticide retreatment.
      • Grabowsky M.
      • Farrell N.
      • Hawley W.
      • et al.
      Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods.
      ,
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      ,
      • Stevens W.
      • Wiseman V.
      • Ortiz J.
      • Chavasse D.
      The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi.
      ,

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      More than half of ITN studies investigated continuous distribution, while others (n = 9, 35%) analyzed campaigns (see Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).

      Indoor-residual spraying (IRS)

      IRS involves spraying interior surfaces of dwellings with a residual insecticide to kill or repel endophilic mosquitoes. Of the 3 eligible IRS studies, 1 concerned 2017 cost estimates of the United States President’s Malaria Initiative IRS programs across 12 countries
      • Cico A.
      • Johns B.
      • Abt Associates I.
      PMI IRS Country Programs: 2017 Comparative Cost Analysis.
      while the other 2 analyzed initiatives from 2006
      • Pemba D.F.
      • Bandason E.
      • Namangale J.
      Comparison of deltamethrin as indoor residual spray or on insecticide treated nets for mosquito control in Lake Chilwa.
      or before 2000

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      (see Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).

      Larval source management (LSM)

      LSM involves the management of aquatic habitats, which are potential habitats for mosquito larvae, to prevent completion of development of the immature stages. LSM studies concerned larviciding,
      • Dambach P.
      • Schleicher M.
      • Stahl H.C.
      • et al.
      Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso.
      • Kusumawathie P.H.D.
      • Wickremasinghe A.R.
      • Karunaweera N.D.
      • Wijeyaratne M.J.S.
      Costs and effectiveness of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river basins below the major dams of Sri Lanka.
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      • Rahman R.
      • Lesser A.
      • Mboera L.
      • Kramer R.
      Cost of microbial larviciding for malaria control in rural Tanzania.
      • Worrall E.
      • Fillinger U.
      Large-scale use of mosquito larval source management for malaria control in Africa: a cost analysis.
      which is the regular application of biological or chemical insecticides to water bodies. All but one
      • Kusumawathie P.H.D.
      • Wickremasinghe A.R.
      • Karunaweera N.D.
      • Wijeyaratne M.J.S.
      Costs and effectiveness of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river basins below the major dams of Sri Lanka.
      were published after 2010
      • Dambach P.
      • Schleicher M.
      • Stahl H.C.
      • et al.
      Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso.
      ,
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      • Rahman R.
      • Lesser A.
      • Mboera L.
      • Kramer R.
      Cost of microbial larviciding for malaria control in rural Tanzania.
      • Worrall E.
      • Fillinger U.
      Large-scale use of mosquito larval source management for malaria control in Africa: a cost analysis.
      (see Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).

      Unit cost and cost-effectiveness of vector control interventions

      From a provider perspective, the median economic cost per person protected per year (PPPY) with ITN was US$1.39 (interquartile range [IQR] 0.72),
      • Scates S J.Y.
      Mass Campaigns and Routine Distribution in Mali.

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(a).

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(b).

      ,
      • Wisniewski J
      • Yukich J
      Cost Analysis Series Routine Facility-Based Distrbution in Main Tanzania.
      • Yukich J.
      Ghana LLIN Continuous Distribution Cost Analysis.
      • Yukich J.
      Continuous Distribution – Zanzibar.
      with IRS $5.70 (IQR 2.0)

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      ,
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      ,
      • Cico A.
      • Johns B.
      • Abt Associates I.
      PMI IRS Country Programs: 2017 Comparative Cost Analysis.
      and with larviciding $1.18 (IQR 0.54) (see Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      • Rahman R.
      • Lesser A.
      • Mboera L.
      • Kramer R.
      Cost of microbial larviciding for malaria control in rural Tanzania.
      • Worrall E.
      • Fillinger U.
      Large-scale use of mosquito larval source management for malaria control in Africa: a cost analysis.
      Additional unit economic cost measures for ITN included $1.77 (IQR 1.46) per treated net year (TNY)
      • Kolaczinski J.H.
      • Kolaczinski K.
      • Kyabayinze D.
      • et al.
      Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.
      ,

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(a).

      ,

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(b).

      ,
      • Stevens W.
      • Wiseman V.
      • Ortiz J.
      • Chavasse D.
      The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi.
      ,
      • Wisniewski J
      • Yukich J
      Cost Analysis Series Routine Facility-Based Distrbution in Main Tanzania.
      • Yukich J.
      Ghana LLIN Continuous Distribution Cost Analysis.
      • Yukich J.
      Continuous Distribution – Zanzibar.
      and $5.13 (IQR 3.76) per net distributed (Appendix 3).
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      ,
      • De Allegri M.
      Comparative cost analysis of insecticide-treatment net delivery strategies: sales supported by social marketing and free distribution through antenatal care.
      ,
      • Kolaczinski J.H.
      • Kolaczinski K.
      • Kyabayinze D.
      • et al.
      Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.
      ,
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      ,
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      ,
      • Scates S J.Y.
      Mass Campaigns and Routine Distribution in Mali.

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(a).

      Scates S, Yukich J. School Net Program – Round 3 (SNP3) in Tanzania. 2017(b).

      ,
      • Smith Paintain L.
      • Awini E.
      • Addei S.
      • et al.
      Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.
      • Stevens W.
      • Wiseman V.
      • Ortiz J.
      • Chavasse D.
      The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi.
      WHO
      Costing of ZMCP ITN Program: Report of a Consultation.
      WHO
      Costing of Uganda ITN Activities: Report of a Consultation.
      WHO
      Costing of PSI-Kenya ITN Program: Report of a Consultation.
      • Wisniewski J
      • Yukich J
      Cost Analysis Series Routine Facility-Based Distrbution in Main Tanzania.
      • Yukich J.
      Ghana LLIN Continuous Distribution Cost Analysis.
      • Yukich J.
      Continuous Distribution – Zanzibar.

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      ,
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      Cost category data suggest that nets represent nearly half of the cost per ITN distributed, while once excluded, personnel is the main cost category, followed by education/communication activities (IEC) and transport (see Appendix 4 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013). IRS and larviciding studies suggested insecticide to be the largest cost category, followed for IRS by project management and spray operations (see Appendix 5 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013) and for larviciding by personnel (see Appendix 6 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).
      Of all the interventions, ITNs had the most cost-effectiveness data. ITN cost-effectiveness compared with no ITN was $5.85 per episode averted (IQR 5.96)
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      and, on average, $1281.97 (IQR 998.24) per death averted
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      ,
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      ,
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      ,

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      and $44.51 (IQR 35.04) per DALY averted
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      ,
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      ,
      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      ,
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      from a provider perspective across several sub-Saharan African settings (Table 1). Using different insecticides in South Africa and Mozambique, IRS cost-effectiveness compared to no IRS, from the provider perspective, was $840.44 per death averted and $25.16 per DALY averted.

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      In a high-transmission setting of Tanzania, larviciding cost-effectiveness compared to no larviciding was $2.62 per case averted, $2412.17 per death averted, and $46.87 per DALY averted from a societal perspective
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      (see Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).
      Table 1Summary of cost-effectiveness data from eligible studies, by health outcome measure and intervention type (constant USD 2018).
      ITNIRSLarvicidingIPTiIPTpSMCTreatment ±Surveillance– systems for epidemicsSurveillance–active case detection
      Provider economic cost per episode averted
      Median/min-max/point estimate$5.85--4.38-121.500.301.28-389.8279.25
      Interquartile range (IQR)5.96--5.67-121.811.47N/AN/A
      Number of point estimates30015010621
      Number of studies2
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      ,
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      002
      • Conteh L.
      • Sicuri E.
      • Manzi F.
      • et al.
      The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.
      ,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      02
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      ,
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      1
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      1
      • Mueller D.H.
      • Abeku T.A.
      • Okia M.
      • Rapuoda B.
      • Cox J.
      Costs of early detection systems for epidemic malaria in highland areas of Kenya and Uganda.
      1
      • Larson B.A.
      • Ngoma T.
      • Silumbe K.
      • et al.
      A framework for evaluating the costs of malaria elimination interventions: an application to reactive case detection in Southern Province of Zambia, 2014.
      Societal economic cost per episode averted
      Median/min-max/point estimate$137.34
      Study of ITN hammock.
      -2.62--177.3430.99
      Savings in treatment intervention using ACT compared with monotherapies91
      --
      Interquartile range (IQR)N/A-N/A--160.282.34--
      Number of point estimates101004600
      Number of studies1
      • Morel C.M.
      • Thang N.D.
      • Erhart A.
      • et al.
      Cost-effectiveness of long-lasting insecticide-treated hammocks in preventing malaria in south-central Vietnam.
      01
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      002
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      ,
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      1
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      00
      Provider economic cost per death averted
      Median/min-max/point estimate1281.99767.60-913.30-271.13-3496.26--39 628.04
      Interquartile range (IQR)998.24N/A-73.84-N/A--N/A
      Number of point estimates1620401001
      Number of studies5
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      ,
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      ,

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      Two references cover the same study37,39
      1

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      01
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      01
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      001
      • Larson B.A.
      • Ngoma T.
      • Silumbe K.
      • et al.
      A framework for evaluating the costs of malaria elimination interventions: an application to reactive case detection in Southern Province of Zambia, 2014.
      Societal economic cost per death averted
      Median/min-max/point estimate7214.30-2412.17--10 449.503025.10--
      Interquartile range (IQR)N/A-N/A--N/AN/A--
      Number of point estimates101001100
      Number of studies1
      • Mulligan J.A.
      • Yukich J.
      • Hanson K.
      Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.
      ,
      • Smith Paintain L.
      • Awini E.
      • Addei S.
      • et al.
      Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.
      01
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      001
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      1
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      00
      Provider economic cost per DALY averted
      Median/min-max/point estimate44.5123.22-27.09-10.41--13.5124.38-623.75974.46
      Interquartile range (IQR)35.04N/A-13.87--N/AN/AN/A
      Number of point estimates14201400121
      Number of studies3
      • Becker-Dreps S.I.
      • Biddle A.K.
      • Pettifor A.
      • et al.
      Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo.
      ,
      • Mueller D.H.
      • Wiseman V.
      • Bakusa D.
      • Morgah K.
      • Dare A.
      • Tchamdja P.
      Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign.
      ,
      • Yukich J.
      • Zerom M.
      • Ghebremeskel T.
      • Tediosi F.
      • Lengeler C.
      Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.
      ,
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      Two references cover the same study37,39
      1

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      02
      • Conteh L.
      • Sicuri E.
      • Manzi F.
      • et al.
      The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.
      ,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      001
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      1
      • Zelman B.W.
      • Baral R.
      • Zarlinda I.
      • et al.
      Costs and cost-effectiveness of malaria reactive case detection using loop-mediated isothermal amplification compared to microscopy in the low transmission setting of Aceh Province, Indonesia.
      1
      • Larson B.A.
      • Ngoma T.
      • Silumbe K.
      • et al.
      A framework for evaluating the costs of malaria elimination interventions: an application to reactive case detection in Southern Province of Zambia, 2014.
      Societal economic cost per DALY averted
      Median/min-max/point estimate--46.87-1.38-50.17-105.59--
      Interquartile range (IQR)--N/A-N/A-N/A--
      Number of point estimates001020100
      Number of studies001
      • Maheu-Giroux M.
      • Castro M.C.
      Cost-effectiveness of larviciding for urban malaria control in Tanzania.
      02
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      ,
      • Sicuri E.
      • Bardaji A.
      • Nhampossa T.
      • et al.
      Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in Southern Mozambique.
      01
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      00
      Summary statistics are presented when there were enough data (refer to number of studies for given category); otherwise point estimate or range are presented. N/A indicates not applicable; –, no data; ±, all data for uncomplicated case treatment; ITN, insecticide-treated net; IRS, indoor residual spraying; IPTi, intermittent preventive treatment for infants; IPTp, intermittent preventive treatment for pregnant women; SMC, seasonal malaria chemoprevention.
      Study of ITN hammock.
      Savings in treatment intervention using ACT compared with monotherapies
      • Onwujekwe O.
      • Uzochukwu B.
      • Ojukwu J.
      • Dike N.
      • Shu E.
      Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.
      Two references cover the same study

      Yukich J, Tediosi F, Lengeler C. Operations, Costs and Cost-Effectiveness of Five Insecticide-Treated Net Programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and Two Indoor Residual Spraying Programs (Kwa-Zulu-Natal, Mozambique); Washington, D.C: USAID; 2007.

      ,
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.

      Chemoprevention

      Chemoprevention is used for preventive treatment using antimalarial medicines and aims to prevent malarial illness by maintaining therapeutic drug levels in the blood throughout the period of greatest risk.
      Eligible studies concerned seasonal chemoprevention in children (SMC) (n = 5, 42%)
      • Bojang K.A.
      • Akor F.
      • Conteh L.
      • et al.
      Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial.
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.

      Pitt C, Ndiaye M, Conteh L, et al. Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis. 2017;32(9):1256-1266.

      and intermittent preventive treatment in pregnant women (IPTp) (n = 4, 33%)
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      ,
      • Manzi F.
      • Hutton G.
      • Schellenberg J.
      • et al.
      From strategy development to routine implementation: the cost of intermittent preventive treatment in infants for malaria control.
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      • Orobaton N.
      • Austin A.M.
      • Abegunde D.
      • et al.
      Scaling-up the use of sulfadoxine-pyrimethamine for the preventive treatment of malaria in pregnancy: results and lessons on scalability, costs and programme impact from three local government areas in Sokoto State, Nigeria.
      and in infants (IPTi) (n = 3, 25%).
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
      ,

      Pitt C, Ndiaye M, Conteh L, et al. Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis. 2017;32(9):1256-1266.

      ,
      • Sicuri E.
      • Bardaji A.
      • Nhampossa T.
      • et al.
      Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in Southern Mozambique.
      Cost-effectiveness was explored by 2 studies each on SMC,
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      ,
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      IPTp,
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      ,
      • Sicuri E.
      • Bardaji A.
      • Nhampossa T.
      • et al.
      Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in Southern Mozambique.
      and IPTi
      • Conteh L.
      • Sicuri E.
      • Manzi F.
      • et al.
      The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.
      ,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      (see Appendix 7 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).
      Chemoprevention eligible studies were all published after 2009.

      Seasonal chemoprevention in children (SMC)

      SMC is recommended by the WHO for all children <6 years during each transmission season in areas with highly seasonal malaria transmission in the sub-Sahel region of Africa. A SMC course was defined as the first dose, given under observation, of each treatment round. All studies had 3 or 4 treatment rounds, with one also evaluating 6 rounds.
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      SMC studies analyzed the delivery costs of using community health workers (CHWs),
      • Bojang K.A.
      • Akor F.
      • Conteh L.
      • et al.
      Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial.
      ,
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
      ,

      Pitt C, Ndiaye M, Conteh L, et al. Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis. 2017;32(9):1256-1266.

      volunteers,
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      ,
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      and/or mobile clinics
      • Bojang K.A.
      • Akor F.
      • Conteh L.
      • et al.
      Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial.
      ,
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
      or static facilities.
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.

      Intermittent preventive treatment in pregnant women (IPTp)

      IPTp is recommended for all women in their first or second pregnancy as part of antenatal care in malaria-endemic areas in Africa. IPTp studies took place at antenatal clinics
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      ,
      • Sicuri E.
      • Bardaji A.
      • Nhampossa T.
      • et al.
      Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in Southern Mozambique.
      ,
      • Fernandes S.
      • Sicuri E.
      • Halimatou D.
      • et al.
      Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial.
      or in the community.
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      ,
      • Orobaton N.
      • Austin A.M.
      • Abegunde D.
      • et al.
      Scaling-up the use of sulfadoxine-pyrimethamine for the preventive treatment of malaria in pregnancy: results and lessons on scalability, costs and programme impact from three local government areas in Sokoto State, Nigeria.

      Intermittent preventive treatment of malaria in infants (IPTi)

      IPTI is recommended for infants (<1 year of age) at the time of the second and third rounds of vaccination against DTP and against measles in areas of moderate to high malaria transmission in Africa. IPTi studies examined delivery at public health facilities and/or EPI/mobile clinics.

      Unit cost and cost-effectiveness of chemoprevention

      From a provider perspective, the median economic cost per child receiving a SMC course was $5.97 (IQR 6.79),
      • Bojang K.A.
      • Akor F.
      • Conteh L.
      • et al.
      Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial.
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.

      Pitt C, Ndiaye M, Conteh L, et al. Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis. 2017;32(9):1256-1266.

      and from a societal perspective in Ghana it was $71.
      • Yukich J.O.
      • Lengeler C.
      • Tediosi F.
      • et al.
      Costs and consequences of large-scale vector control for malaria.
      ,
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      Training, supervision, and distribution were the largest cost categories (see Appendix 8 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).
      • Bojang K.A.
      • Akor F.
      • Conteh L.
      • et al.
      Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial.
      • Patouillard E.
      • Conteh L.
      • Webster J.
      • Kweku M.
      • Chandramohan D.
      • Greenwood B.
      Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      The average cost per IPT dose administered to a pregnant woman was estimated at $0.86 (95% CI 0.58-1.22), including drug and personnel cost only.
      • Fernandes S.
      • Sicuri E.
      • Halimatou D.
      • et al.
      Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial.
      The societal cost per course of 2 IPTp doses ranged between $3.02 and $3.31 depending on the delivery platform, with distribution and user costs reported as main cost categories
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      (see Appendix 7 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013). For IPTi, the median economic cost per infant protected (having received 3 doses) was $0.53 (IQR 0.59)
      • Manzi F.
      • Hutton G.
      • Schellenberg J.
      • et al.
      From strategy development to routine implementation: the cost of intermittent preventive treatment in infants for malaria control.
      ,
      • Conteh L.
      • Sicuri E.
      • Manzi F.
      • et al.
      The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.
      ,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      with drug cost, training, and IEC as the main unit cost categories (see Appendix 8 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).
      The cost-effectiveness of SMC was examined in Ghanaian settings only: the median cost per episode averted using different antimalarial drug regimens at community level was $121.50 (IQR 121.81) from a provider perspective and $177.34 (IQR 160.28) from a societal perspective.
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      ,
      • Conteh L.
      • Patouillard E.
      • Kweku M.
      • Legood R.
      • Greenwood B.
      • Chandramohan D.
      Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine and artesunate or sulphadoxine-pyrimethamine in Ghanaian children.
      The cost per death averted with SMC was $3496 and $10 450 from a provider and societal perspective, respectively
      • Nonvignon J.
      • Aryeetey G.C.
      • Issah S.
      • et al.
      Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.
      (Appendix 7 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013 and Table 1). Two studies examined the cost-effectiveness of IPTp, both from the societal perspective,
      • Mbonye A.K.
      • Hansen K.S.
      • Bygbjerg I.C.
      • Magnussen P.
      Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
      ,
      • Sicuri E.
      • Bardaji A.
      • Nhampossa T.
      • et al.
      Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in Southern Mozambique.
      with a median cost of $25.78 per DALY averted (Appendix 7 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013 and Table 1). Finally, depending on the drug regimen used, study location and transmission seasonality, IPTi cost-effectiveness from a provider perspective ranged between $0.86 and $22.46 per malaria episode averted,
      • Conteh L.
      • Sicuri E.
      • Manzi F.
      • et al.
      The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.
      ,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      $125.25 and $376.38 per death averted,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      and $3.51 and $47.95 per DALY averted
      • Conteh L.
      • Sicuri E.
      • Manzi F.
      • et al.
      The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.
      ,
      • Hutton G.
      • Schellenberg D.
      • Tediosi F.
      • et al.
      Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
      (Appendix 7 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013 and Table 1), largely driven by the very low unit cost of delivering the intervention.

      Diagnosis

      All suspected malaria cases should be confirmed with a parasitological test, including RDT or microscopy. Diagnostic eligible studies examined RDT (17, 94%)
      • Ansah E.K.
      • Epokor M.
      • Whitty C.J.
      • Yeung S.
      • Hansen K.S.
      Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana.
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      • Chanda P.
      • Castillo-Riquelme M.
      • Masiye F.
      Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia.
      • de Oliveira M.R.
      • de Castro Gomes A.
      • Toscano C.M.
      Cost effectiveness of OptiMal rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.
      • de Oliveira M.R.
      • Giozza S.P.
      • Peixoto H.M.
      • Romero G.A.
      Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil.
      • Faye A.
      • Ndiaye P.
      • Diagne-Camara M.
      • et al.
      [Economic evaluation of rapid diagnostic tests in malaria treatment]. [French].

      Hansen KS, Clarke SE, Lal S, Magnussen P, Mbonye AK. Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda. 2017;12(12):e0189758.

      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.

      Hansen KS, Ndyomugyenyi R, Magnussen P, Lal S, Clarke SE. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda. 2017;15:15.

      • Lemma H.
      • San Sebastian M.
      • Lofgren C.
      • Barnabas G.
      Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate.
      • Lubell Y.
      • Reyburn H.
      • Mbakilwa H.
      • et al.
      The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy.
      • Matangila J.R.
      • Lufuluabo J.
      • Ibalanky A.L.
      • Inocencio Da Luz R.A.
      • Lutumba P.
      • Van Geertruyden J.P.
      Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
      • Ogunniyi A.
      • Dairo M.D.
      • Dada-Adegbola H.
      • et al.
      Cost-effectiveness and validity assessment of cyscope microscope, quantitative buffy coat microscope, and rapid diagnostic kit for malaria diagnosis among clinic attendees in Ibadan, Nigeria.
      • Rolland E.
      • Checchi F.
      • Pinoges L.
      • Balkan S.
      • Guthmann J.P.
      • Guerin P.J.
      Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?.
      • Tawiah T.
      • Hansen K.S.
      • Baiden F.
      • et al.
      Cost-effectiveness analysis of test-based versus presumptive treatment of uncomplicated malaria in children under five years in an area of high transmission in central Ghana.
      • Willcox M.L.
      • Sanogo F.
      • Graz B.
      • et al.
      Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.
      • Yukich J.
      • D'Acremont V.
      • Kahama J.
      • Swai N.
      • Lengeler C.
      Cost savings with rapid diagnostic tests for malaria in low-transmission areas: evidence from Dar es Salaam, Tanzania.
      and/or microscopy (n = 8, 50%)
      • Ansah E.K.
      • Epokor M.
      • Whitty C.J.
      • Yeung S.
      • Hansen K.S.
      Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana.
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      • Chanda P.
      • Castillo-Riquelme M.
      • Masiye F.
      Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia.
      • de Oliveira M.R.
      • de Castro Gomes A.
      • Toscano C.M.
      Cost effectiveness of OptiMal rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.
      • de Oliveira M.R.
      • Giozza S.P.
      • Peixoto H.M.
      • Romero G.A.
      Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil.
      ,
      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.
      ,
      • Matangila J.R.
      • Lufuluabo J.
      • Ibalanky A.L.
      • Inocencio Da Luz R.A.
      • Lutumba P.
      • Van Geertruyden J.P.
      Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
      ,
      • Ogunniyi A.
      • Dairo M.D.
      • Dada-Adegbola H.
      • et al.
      Cost-effectiveness and validity assessment of cyscope microscope, quantitative buffy coat microscope, and rapid diagnostic kit for malaria diagnosis among clinic attendees in Ibadan, Nigeria.
      ,
      • Parikh R.
      • Amole I.
      • Tarpley M.
      • Gbadero D.
      • Davidson M.
      • Vermund S.H.
      Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: A prospective study.
      delivered to all-age presumptive malaria cases,
      • Ansah E.K.
      • Epokor M.
      • Whitty C.J.
      • Yeung S.
      • Hansen K.S.
      Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana.
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      • Chanda P.
      • Castillo-Riquelme M.
      • Masiye F.
      Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia.
      • de Oliveira M.R.
      • de Castro Gomes A.
      • Toscano C.M.
      Cost effectiveness of OptiMal rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.
      • de Oliveira M.R.
      • Giozza S.P.
      • Peixoto H.M.
      • Romero G.A.
      Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil.
      • Faye A.
      • Ndiaye P.
      • Diagne-Camara M.
      • et al.
      [Economic evaluation of rapid diagnostic tests in malaria treatment]. [French].

      Hansen KS, Clarke SE, Lal S, Magnussen P, Mbonye AK. Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda. 2017;12(12):e0189758.

      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.

      Hansen KS, Ndyomugyenyi R, Magnussen P, Lal S, Clarke SE. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda. 2017;15:15.

      • Lemma H.
      • San Sebastian M.
      • Lofgren C.
      • Barnabas G.
      Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate.
      • Lubell Y.
      • Reyburn H.
      • Mbakilwa H.
      • et al.
      The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy.
      ,
      • Ogunniyi A.
      • Dairo M.D.
      • Dada-Adegbola H.
      • et al.
      Cost-effectiveness and validity assessment of cyscope microscope, quantitative buffy coat microscope, and rapid diagnostic kit for malaria diagnosis among clinic attendees in Ibadan, Nigeria.
      ,
      • Rolland E.
      • Checchi F.
      • Pinoges L.
      • Balkan S.
      • Guthmann J.P.
      • Guerin P.J.
      Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?.
      ,
      • Willcox M.L.
      • Sanogo F.
      • Graz B.
      • et al.
      Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.
      • Yukich J.
      • D'Acremont V.
      • Kahama J.
      • Swai N.
      • Lengeler C.
      Cost savings with rapid diagnostic tests for malaria in low-transmission areas: evidence from Dar es Salaam, Tanzania.
      • Parikh R.
      • Amole I.
      • Tarpley M.
      • Gbadero D.
      • Davidson M.
      • Vermund S.H.
      Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: A prospective study.
      children under 5 years of age with fever,
      • Tawiah T.
      • Hansen K.S.
      • Baiden F.
      • et al.
      Cost-effectiveness analysis of test-based versus presumptive treatment of uncomplicated malaria in children under five years in an area of high transmission in central Ghana.
      or pregnant women
      • Matangila J.R.
      • Lufuluabo J.
      • Ibalanky A.L.
      • Inocencio Da Luz R.A.
      • Lutumba P.
      • Van Geertruyden J.P.
      Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
      at health facilities,
      • Ansah E.K.
      • Epokor M.
      • Whitty C.J.
      • Yeung S.
      • Hansen K.S.
      Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana.
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      • Chanda P.
      • Castillo-Riquelme M.
      • Masiye F.
      Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia.
      • de Oliveira M.R.
      • de Castro Gomes A.
      • Toscano C.M.
      Cost effectiveness of OptiMal rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.
      • de Oliveira M.R.
      • Giozza S.P.
      • Peixoto H.M.
      • Romero G.A.
      Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil.
      • Faye A.
      • Ndiaye P.
      • Diagne-Camara M.
      • et al.
      [Economic evaluation of rapid diagnostic tests in malaria treatment]. [French].
      ,
      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.
      ,
      • Lemma H.
      • San Sebastian M.
      • Lofgren C.
      • Barnabas G.
      Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate.
      • Lubell Y.
      • Reyburn H.
      • Mbakilwa H.
      • et al.
      The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy.
      • Matangila J.R.
      • Lufuluabo J.
      • Ibalanky A.L.
      • Inocencio Da Luz R.A.
      • Lutumba P.
      • Van Geertruyden J.P.
      Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
      • Ogunniyi A.
      • Dairo M.D.
      • Dada-Adegbola H.
      • et al.
      Cost-effectiveness and validity assessment of cyscope microscope, quantitative buffy coat microscope, and rapid diagnostic kit for malaria diagnosis among clinic attendees in Ibadan, Nigeria.
      ,
      • Tawiah T.
      • Hansen K.S.
      • Baiden F.
      • et al.
      Cost-effectiveness analysis of test-based versus presumptive treatment of uncomplicated malaria in children under five years in an area of high transmission in central Ghana.
      ,
      • Yukich J.
      • D'Acremont V.
      • Kahama J.
      • Swai N.
      • Lengeler C.
      Cost savings with rapid diagnostic tests for malaria in low-transmission areas: evidence from Dar es Salaam, Tanzania.
      ,
      • Parikh R.
      • Amole I.
      • Tarpley M.
      • Gbadero D.
      • Davidson M.
      • Vermund S.H.
      Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: A prospective study.
      drug shops,

      Hansen KS, Clarke SE, Lal S, Magnussen P, Mbonye AK. Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda. 2017;12(12):e0189758.

      or in the community

      Hansen KS, Ndyomugyenyi R, Magnussen P, Lal S, Clarke SE. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda. 2017;15:15.

      ,
      • Rolland E.
      • Checchi F.
      • Pinoges L.
      • Balkan S.
      • Guthmann J.P.
      • Guerin P.J.
      Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?.
      ,
      • Willcox M.L.
      • Sanogo F.
      • Graz B.
      • et al.
      Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.
      (see Appendix 9 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).

      Unit cost of diagnosis

      Most studies analyzed the cost per case diagnosed and/or the cost per case diagnosed and treated, while others also examined the cost per additional case diagnosed and treated with RDT or microscopy compared to presumptive diagnosis (n = 9) and/or the cost per additional case diagnosed and/or treated with RDT/microscopy compared to microscopy/RDT (n = 3) (Appendix 9). Four studies estimated RDT unit cost for different malaria transmission risk
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      ,
      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.
      ,

      Hansen KS, Ndyomugyenyi R, Magnussen P, Lal S, Clarke SE. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda. 2017;15:15.

      ,
      • Lubell Y.
      • Reyburn H.
      • Mbakilwa H.
      • et al.
      The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy.
      or prevalence
      • Rolland E.
      • Checchi F.
      • Pinoges L.
      • Balkan S.
      • Guthmann J.P.
      • Guerin P.J.
      Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?.
      levels. (Appendix 9). From a provider perspective, the median economic cost per case diagnosed with RDT was $6.06 (IQR 6.23)
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      • Chanda P.
      • Castillo-Riquelme M.
      • Masiye F.
      Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia.
      • de Oliveira M.R.
      • de Castro Gomes A.
      • Toscano C.M.
      Cost effectiveness of OptiMal rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.
      ,
      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.
      ,
      • Matangila J.R.
      • Lufuluabo J.
      • Ibalanky A.L.
      • Inocencio Da Luz R.A.
      • Lutumba P.
      • Van Geertruyden J.P.
      Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
      ,
      • Tawiah T.
      • Hansen K.S.
      • Baiden F.
      • et al.
      Cost-effectiveness analysis of test-based versus presumptive treatment of uncomplicated malaria in children under five years in an area of high transmission in central Ghana.
      and with microscopy $2.53 (IQR 5.24)
      • Batwala V.
      • Magnussen P.
      • Hansen K.S.
      • Nuwaha F.
      Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda.
      • Chanda P.
      • Castillo-Riquelme M.
      • Masiye F.
      Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia.
      • de Oliveira M.R.
      • de Castro Gomes A.
      • Toscano C.M.
      Cost effectiveness of OptiMal rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.
      ,
      • Hansen K.S.
      • Grieve E.
      • Mikhail A.
      • et al.
      Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan.
      ,
      • Matangila J.R.
      • Lufuluabo J.
      • Ibalanky A.L.
      • Inocencio Da Luz R.A.
      • Lutumba P.
      • Van Geertruyden J.P.
      Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.
      The main cost categories included personnel, commodities, and supplies (see Appendix 10 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.01.013).

      Treatment

      Five parasite species cause malaria in humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium knowlesi. The first 2 pose the greatest health threat.
      WHO
      World Malaria Report 2019.
      A patient with uncomplicated malaria is a patient who presents with symptoms of malaria and a positive parasitological test but with no features of severe malaria. Uncomplicated malaria is assumed to be treated by outpatient health facility services or at the community level. Severe malaria is generally treated by inpatient healthcare services. Eligible treatment studies related to malaria treatment in children and adults (except pregnant women in their first trimester) with uncomplicated malaria or with severe malaria.
      Studies examined the cost of treating Plasmodium falciparum malaria (n = 18, 86%)
      • Abotsi A.K.
      Cost burden of infant malaria treatment on households and health institutions in the upper east region.
      • Ayieko P.
      • Akumu A.O.
      • Griffiths U.K.
      • English M.
      The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis.
      • Chanda P.
      • Hamainza B.
      • Moonga H.B.
      • Chalwe V.
      • Banda P.
      • Pagnoni F.
      Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management.
      • Chanda P.
      • Masiye F.
      • Chitah B.M.
      • et al.
      A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia.
      • Collins D.
      • Jarrah Z.
      • Gilmartin C.
      • Saya U.
      The costs of integrated community case management (iCCM) programs: a multi-country analysis.
      • Comfort A.B.
      • van Dijk J.H.
      • Mharakurwa S.
      • et al.
      Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.
      • Daviaud E.
      • Besada D.
      • Leon N.
      • et al.
      Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.
      • Escribano Ferrer B.
      • Hansen K.S.
      • Gyapong M.
      • et al.
      Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.
      • Ezenduka C.C.
      • Falleiros D.R.
      • Godman B.B.
      Evaluating the treatment costs for uncomplicated malaria at a public healthcare facility in Nigeria and the implications.
      • Ferrari G.
      • Maggi Ntuku H.
      • Burri C.
      • et al.
      An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study.
      • Kyaw S.S.
      • Drake T.
      • Ruangveerayuth R.
      • Chierakul W.
      • White N.J.
      • Newton P.N.
      Cost of treating inpatient falciparum malaria on the Thai-Myanmar border.
      • Maka D.E.
      • Chiabi A.
      • Obadeyi B.
      • et al.
      Economic evaluation of artesunate and three quinine regimens in the treatment of severe malaria in children at the Ebolowa Regional Hospital-Cameroon: a cost analysis.
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      • Onwujekwe O.
      • Uguru N.
      • Etiaba E.
      • Chikezie I.
      • Uzochukwu B.
      • Adjagba A.
      The economic burden of malaria on households and the health system in Enugu state southeast Nigeria.
      • Onwujekwe O.
      • Uzochukwu B.
      • Ojukwu J.
      • Dike N.
      • Shu E.
      Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      • Yeung S.
      • Van Damme W.
      • Socheat D.
      • White N.J.
      • Mills A.
      Cost of increasing access to artemisinin combination therapy: the Cambodian experience.
      or both Plasmodium falciparum and Plasmodium vivax
      • Botto-Menezes C.
      • Bardaji A.
      • Dos Santos Campos G.
      • et al.
      Costs associated with malaria in pregnancy in the Brazilian Amazon, a low endemic area where plasmodium vivax predominates.
      • Davis W.A.
      • Clarke P.M.
      • Siba P.M.
      • et al.
      Cost-effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea.
      • Moore B.R.
      • Davis W.A.
      • Clarke P.M.
      • Robinson L.J.
      • Laman M.
      • Davis T.M.E.
      Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children.
      (Appendix 9). Cost-effectiveness was analyzed in 5 studies.
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      ,
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      ,
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      ,
      • Davis W.A.
      • Clarke P.M.
      • Siba P.M.
      • et al.
      Cost-effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea.
      ,
      • Moore B.R.
      • Davis W.A.
      • Clarke P.M.
      • Robinson L.J.
      • Laman M.
      • Davis T.M.E.
      Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children.
      Most studies were published after 2010
      • Abotsi A.K.
      Cost burden of infant malaria treatment on households and health institutions in the upper east region.
      ,
      • Chanda P.
      • Hamainza B.
      • Moonga H.B.
      • Chalwe V.
      • Banda P.
      • Pagnoni F.
      Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management.
      ,
      • Collins D.
      • Jarrah Z.
      • Gilmartin C.
      • Saya U.
      The costs of integrated community case management (iCCM) programs: a multi-country analysis.
      • Comfort A.B.
      • van Dijk J.H.
      • Mharakurwa S.
      • et al.
      Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.
      • Daviaud E.
      • Besada D.
      • Leon N.
      • et al.
      Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.
      • Escribano Ferrer B.
      • Hansen K.S.
      • Gyapong M.
      • et al.
      Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.
      • Ezenduka C.C.
      • Falleiros D.R.
      • Godman B.B.
      Evaluating the treatment costs for uncomplicated malaria at a public healthcare facility in Nigeria and the implications.
      • Ferrari G.
      • Maggi Ntuku H.
      • Burri C.
      • et al.
      An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study.
      • Kyaw S.S.
      • Drake T.
      • Ruangveerayuth R.
      • Chierakul W.
      • White N.J.
      • Newton P.N.
      Cost of treating inpatient falciparum malaria on the Thai-Myanmar border.
      • Maka D.E.
      • Chiabi A.
      • Obadeyi B.
      • et al.
      Economic evaluation of artesunate and three quinine regimens in the treatment of severe malaria in children at the Ebolowa Regional Hospital-Cameroon: a cost analysis.
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      • Onwujekwe O.
      • Uguru N.
      • Etiaba E.
      • Chikezie I.
      • Uzochukwu B.
      • Adjagba A.
      The economic burden of malaria on households and the health system in Enugu state southeast Nigeria.
      ,
      • Botto-Menezes C.
      • Bardaji A.
      • Dos Santos Campos G.
      • et al.
      Costs associated with malaria in pregnancy in the Brazilian Amazon, a low endemic area where plasmodium vivax predominates.
      ,
      • Moore B.R.
      • Davis W.A.
      • Clarke P.M.
      • Robinson L.J.
      • Laman M.
      • Davis T.M.E.
      Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children.
      and concerned uncomplicated malaria only,
      • Chanda P.
      • Hamainza B.
      • Moonga H.B.
      • Chalwe V.
      • Banda P.
      • Pagnoni F.
      Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management.
      ,
      • Collins D.
      • Jarrah Z.
      • Gilmartin C.
      • Saya U.
      The costs of integrated community case management (iCCM) programs: a multi-country analysis.
      ,
      • Daviaud E.
      • Besada D.
      • Leon N.
      • et al.
      Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.
      • Escribano Ferrer B.
      • Hansen K.S.
      • Gyapong M.
      • et al.
      Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.
      • Ezenduka C.C.
      • Falleiros D.R.
      • Godman B.B.
      Evaluating the treatment costs for uncomplicated malaria at a public healthcare facility in Nigeria and the implications.
      ,
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      ,
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      ,
      • Onwujekwe O.
      • Uzochukwu B.
      • Ojukwu J.
      • Dike N.
      • Shu E.
      Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      • Yeung S.
      • Van Damme W.
      • Socheat D.
      • White N.J.
      • Mills A.
      Cost of increasing access to artemisinin combination therapy: the Cambodian experience.
      ,
      • Davis W.A.
      • Clarke P.M.
      • Siba P.M.
      • et al.
      Cost-effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea.
      ,
      • Moore B.R.
      • Davis W.A.
      • Clarke P.M.
      • Robinson L.J.
      • Laman M.
      • Davis T.M.E.
      Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children.
      both uncomplicated and severe malaria,
      • Abotsi A.K.
      Cost burden of infant malaria treatment on households and health institutions in the upper east region.
      ,
      • Chanda P.
      • Masiye F.
      • Chitah B.M.
      • et al.
      A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia.
      ,
      • Comfort A.B.
      • van Dijk J.H.
      • Mharakurwa S.
      • et al.
      Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.
      ,
      • Kyaw S.S.
      • Drake T.
      • Ruangveerayuth R.
      • Chierakul W.
      • White N.J.
      • Newton P.N.
      Cost of treating inpatient falciparum malaria on the Thai-Myanmar border.
      ,
      • Onwujekwe O.
      • Uguru N.
      • Etiaba E.
      • Chikezie I.
      • Uzochukwu B.
      • Adjagba A.
      The economic burden of malaria on households and the health system in Enugu state southeast Nigeria.
      ,
      • Botto-Menezes C.
      • Bardaji A.
      • Dos Santos Campos G.
      • et al.
      Costs associated with malaria in pregnancy in the Brazilian Amazon, a low endemic area where plasmodium vivax predominates.
      with severe or moderate anemia
      • Comfort A.B.
      • van Dijk J.H.
      • Mharakurwa S.
      • et al.
      Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.
      or severe malaria only
      • Ayieko P.
      • Akumu A.O.
      • Griffiths U.K.
      • English M.
      The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis.
      ,
      • Ferrari G.
      • Maggi Ntuku H.
      • Burri C.
      • et al.
      An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study.
      ,
      • Maka D.E.
      • Chiabi A.
      • Obadeyi B.
      • et al.
      Economic evaluation of artesunate and three quinine regimens in the treatment of severe malaria in children at the Ebolowa Regional Hospital-Cameroon: a cost analysis.
      in all ages,
      • Chanda P.
      • Hamainza B.
      • Moonga H.B.
      • Chalwe V.
      • Banda P.
      • Pagnoni F.
      Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management.
      ,
      • Collins D.
      • Jarrah Z.
      • Gilmartin C.
      • Saya U.
      The costs of integrated community case management (iCCM) programs: a multi-country analysis.
      ,
      • Daviaud E.
      • Besada D.
      • Leon N.
      • et al.
      Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.
      ,
      • Escribano Ferrer B.
      • Hansen K.S.
      • Gyapong M.
      • et al.
      Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.
      ,
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      ,
      • Onwujekwe O.
      • Uzochukwu B.
      • Ojukwu J.
      • Dike N.
      • Shu E.
      Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.
      ,
      • Yeung S.
      • Van Damme W.
      • Socheat D.
      • White N.J.
      • Mills A.
      Cost of increasing access to artemisinin combination therapy: the Cambodian experience.
      infants/children,
      • Abotsi A.K.
      Cost burden of infant malaria treatment on households and health institutions in the upper east region.
      ,
      • Collins D.
      • Jarrah Z.
      • Gilmartin C.
      • Saya U.
      The costs of integrated community case management (iCCM) programs: a multi-country analysis.
      ,
      • Daviaud E.
      • Besada D.
      • Leon N.
      • et al.
      Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.
      ,
      • Escribano Ferrer B.
      • Hansen K.S.
      • Gyapong M.
      • et al.
      Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.
      ,
      • Ferrari G.
      • Maggi Ntuku H.
      • Burri C.
      • et al.
      An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study.
      ,
      • Maka D.E.
      • Chiabi A.
      • Obadeyi B.
      • et al.
      Economic evaluation of artesunate and three quinine regimens in the treatment of severe malaria in children at the Ebolowa Regional Hospital-Cameroon: a cost analysis.
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      • Nonvignon J.
      • Chinbuah M.A.
      • Gyapong M.
      • et al.
      Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
      • Onwujekwe O.
      • Uguru N.
      • Etiaba E.
      • Chikezie I.
      • Uzochukwu B.
      • Adjagba A.
      The economic burden of malaria on households and the health system in Enugu state southeast Nigeria.
      ,
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      ,
      • Davis W.A.
      • Clarke P.M.
      • Siba P.M.
      • et al.
      Cost-effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea.
      ,
      • Moore B.R.
      • Davis W.A.
      • Clarke P.M.
      • Robinson L.J.
      • Laman M.
      • Davis T.M.E.
      Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children.
      or pregnant or postpartum women
      • Botto-Menezes C.
      • Bardaji A.
      • Dos Santos Campos G.
      • et al.
      Costs associated with malaria in pregnancy in the Brazilian Amazon, a low endemic area where plasmodium vivax predominates.
      (Appendix 9). Studies examined the cost of treatment at health facilities
      • Abotsi A.K.
      Cost burden of infant malaria treatment on households and health institutions in the upper east region.
      • Ayieko P.
      • Akumu A.O.
      • Griffiths U.K.
      • English M.
      The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis.
      • Chanda P.
      • Hamainza B.
      • Moonga H.B.
      • Chalwe V.
      • Banda P.
      • Pagnoni F.
      Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management.
      • Chanda P.
      • Masiye F.
      • Chitah B.M.
      • et al.
      A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia.
      ,
      • Comfort A.B.
      • van Dijk J.H.
      • Mharakurwa S.
      • et al.
      Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.
      ,
      • Ezenduka C.C.
      • Falleiros D.R.
      • Godman B.B.
      Evaluating the treatment costs for uncomplicated malaria at a public healthcare facility in Nigeria and the implications.
      • Ferrari G.
      • Maggi Ntuku H.
      • Burri C.
      • et al.
      An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study.
      • Kyaw S.S.
      • Drake T.
      • Ruangveerayuth R.
      • Chierakul W.
      • White N.J.
      • Newton P.N.
      Cost of treating inpatient falciparum malaria on the Thai-Myanmar border.
      • Maka D.E.
      • Chiabi A.
      • Obadeyi B.
      • et al.
      Economic evaluation of artesunate and three quinine regimens in the treatment of severe malaria in children at the Ebolowa Regional Hospital-Cameroon: a cost analysis.
      • Mori A.T.
      • Ngalesoni F.
      • Norheim O.F.
      • Robberstad B.
      Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
      ,
      • Onwujekwe O.
      • Uguru N.
      • Etiaba E.
      • Chikezie I.
      • Uzochukwu B.
      • Adjagba A.
      The economic burden of malaria on households and the health system in Enugu state southeast Nigeria.
      ,
      • Wiseman V.
      • Kim M.
      • Mutabingwa T.K.
      • Whitty C.J.M.
      Cost-effectiveness study of three antimalarial drug combinations in Tanzania.
      ,
      • Botto-Menezes C.
      • Bardaji A.
      • Dos Santos Campos G.
      • et al.
      Costs associated with malaria in pregnancy in the Brazilian Amazon, a low endemic area where plasmodium vivax predominates.