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This study compared the costs and effects of insecticide (permethrin)-treated bed net (ITN) use in children less than five years of age in an area of intense, perennial malaria transmission in western Kenya. The data were derived from a group-randomized controlled trial of ITNs conducted between 1996 and 1999. The annual net cost per life-year gained was U.S. $34 and the net annual cost per all-cause sick child clinic visit averted was U.S. $49. After taking into account a community effect (protection from malaria afforded to non-ITN users who lived within 300 meters from users) these estimates decreased to U.S. $25 and U.S. $38, respectively. This study provides further evidence that ITNs are a highly cost-effective use of scarce health care resources.
Acknowledgments: We express our gratitude to the children and caregivers who participated in the study and the many people that assisted with this project. We thank Dr. Stephen Jan, Dr. Julia Fox-Rushby, and an anonymous referee for their helpful comments. We also thank the Director of the Kenya Medical Research Institute for his permission to publish this work.
Financial support: The ITN project was funded by the United States Agency for International Development. Virginia Wiseman was supported by the Gates Malaria Partnership of The London School of Hygiene and Tropical Medicine. Feiko O. ter Kuile was partly supported by a grant from the Netherlands Foundation for the Advancement of Tropical Research (WOTRO) (The Hague, The Netherlands).
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Virginia Wiseman and Anne J. Mills, Health Economics and Financing Programme & Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, 50 Bedford Square, London WC1B 3DP, United Kingdom. William A. Hawley, Feiko O. ter Kuile, and Penelope A. Phillips-Howard, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
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