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Cost-Effectiveness of Adding Bed Net Distribution for Malaria Prevention to Antenatal Services in Kinshasa, Democratic Republic of the Congo

We evaluated the cost-effectiveness of distributing insecticide-treated bed nets (ITNs) for malaria prevention at antenatal clinics in Kinshasa, Democratic Republic of the Congo. A decision tree model was used to estimate costs, outcomes, and incremental cost-effectiveness for 17,893 pregnant women attending 28 antenatal clinics who received long-lasting ITNs free of charge. Costs including purchase, transportation, storage, and distribution of ITNs were derived from program records. The ITN efficacy and other parameters were derived from peer-reviewed literature. Outcomes modeled included low birth weight (LBW) deliveries, infant deaths averted, life-years saved (LYs), and disability-adjusted life-years (DALYs) averted. Deterministic and probabilistic sensitivity analyses were conducted. For the 17,893 women in our program, ITN distribution would be expected to avert 587 LBW deliveries and 414 infant deaths. The incremental cost-effectiveness was US $17.22 per DALY averted (95% confidence interval [CI] = US $8.54–$30.90), US $15.70 per LY saved (95% CI = US $7.65–$27.68), and US $411.13 per infant death averted (95% CI = US $353.95–$1,085.89). If resources were constrained, the greatest benefit would be among women in their first through fourth pregnancies. Thus, ITN distribution is a cost-effective addition to antenatal services.

Received August 22, 2008. Accepted for publication June 12, 2009.

Acknowledgments: We thank Sandra Duvall, Stephanie B. Wheeler, and Kashamuka Mwandagalirwa for contributions to this study.

Financial support: This study was supported by the US Centers for Disease Control and Prevention Global AIDS Program (#U62/CCU422422). Long-lasting insecticide-treated nets used in this study were donated by the Global Fund and the US Centers for Disease Control and Prevention. Sylvia Becker-Dreps was supported by a National Research Service Award (grant #5-T32 HP14001-19) from the Health Resources and Services Administration.

^* Address correspondence to Sylvia I. Becker-Dreps, Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Campus Box 7595, Chapel Hill, NC 27599-7595. E-mail: sbd{at}unc.edu

Authors’ addresses: Sylvia I. Becker-Dreps, Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Campus Box 7595, Chapel Hill, NC 27599-7595, E-mail: sbd{at}unc.edu. Andrea K. Biddle, Department of Health Policy and Management, 1105E McGavran-Greenberg Hall, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, E-mail: andrea.biddle{at}unc.edu. Audrey Pettifor and Frieda Behets, Department of Epidemiology, 2102-E McGavran-Greenberg, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7435, Chapel Hill, NC 27599-7435, E-mails: apettif{at}email.unc.edu and Frieda_Behets{at}unc.edu. Gertrude Musuamba, School of Public Health, Kinshasa, Democratic Republic of the Congo, E-mail: gkana_musuamba{at}yahoo.fr. David Nku Imbie, Salvation Army, Kinshasa, Democratic Republic of the Congo, E-mail: david_ nku{at}kin.salvationarmy.org. Steven Meshnick, Department of Epidemiology, 3301 Michael Hooker Research Center, University of North Carolina at Chapel Hill, Campus Box 7435, Chapel Hill, NC 27599-7435, E-mail: meshnick{at}email.unc.edu.