1921
  1. Home
  2. The American Journal of Tropical Medicine and Hygiene
  3. Volume 99, Issue 3
  4. Article
Volume 99, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645
Download

Abstract

Abstract.

Using a decision-tree approach, we examined the cost-effectiveness of indoor residual spraying (IRS) of households with insecticide combined with insecticide-treated bed net (ITN) distribution (IRS + ITN), compared with ITN distribution alone in the programmatic context of mainland Tanzania. The primary outcome of our model was the expected economic cost to society per case of malaria averted in children ≤ 5 years of age. Indoor residual spraying of households with insecticide data came from a program implemented in northwest Tanzania from 2008 to 2012; all other data originated from the published literature. Through sensitivity and scenario analyses, the model also examined the effects of variations in insecticide resistance, malaria prevalence, and different IRS modalities. In the base case, IRS + ITN is expected to be more expensive and more effective than the ITN-only intervention (incremental cost-effectiveness ratio [ICER]: $152.36). The number of IRS rounds, IRS insecticide costs, ITN use, malaria prevalence, and the probability that a child develops symptoms following infection drove the interventions’ cost-effectiveness. Compared with universal spraying, targeted spraying is expected to lead to a higher number of malaria cases per person targeted (0.211–0.256 versus 0.050–0.076), but the incremental cost per case of malaria averted is expected to be lower (ICER: $41.70). In a scenario of increasing pyrethroid resistance, the incremental expected cost per case of malaria averted is expected to increase compared with the base case (ICER: $192.12). Tanzania should pursue universal IRS only in those regions that report high malaria prevalence. If the cost per case of malaria averted of universal IRS exceeds the willingness to pay, targeted spraying could provide an alternative, but may result in higher malaria prevalence.

© The American Society of Tropical Medicine and Hygiene
Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0537
2018-07-16
2019-11-17

  • From This Site

    /content/journals/10.4269/ajtmh.17-0537
    dcterms_title,dcterms_subject,pub_keyword
    10
    5
Loading full text...

Full text loading...

/deliver/fulltext/14761645/99/3/tpmd170537.html?itemId=/content/journals/10.4269/ajtmh.17-0537&mimeType=html&fmt=ahah

References

  1. WHO Global Malaria Programme, 2014. World Malaria Report 2014. Geneva, Switzerland: World Health Organization.
  2. Tanzania Ministry of Health and Social Welfare, 2014. National Malaria Strategic Plan, 2014–2020. Dar-es-Salaam, Tanzania: Ministry of Health and Social Welfare.
  3. Roll Back Malaria Partnership, 2012. Progress & Impact Series: Country Reports. Focus on Mainland Tanzania. Geneva, Switzerland: World Health Organization.
  4. Akim I, Govere J, Gruber J, Ngasala B, , 2014. Tanzania Vector Control Scale Project: Mid-Term Performance Evaluation. Arlington, VA: African Strategies for Health Project.
  5. Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B, , 2012. Malaria resurgence: a systematic review and assessment of its causes. Malar J 11: 112. [Google Scholar]
  6. Colaço R, Yevstigneyeva V, Lalji S, , 2014. Tanzania Vector Control Scale-Up Project: Costs of Indoor Residual Spraying, 2011–2012. Unpublished Manuscript. Dar-es-Salaam, Tanzania: RTI International.
  7. Nájera JA, González-Silva M, Alonso PL, , 2011. Some lessons for the future from the global malaria eradication programme (1955–1969). PLoS Med 8: e1000412. [Google Scholar]
  8. West PA, Protopopoff N, Wright A, Kivaju Z, Tigererwa R, Mosha FW, Kisinza W, Rowland M, Kleinschmidt I, , 2014. Indoor residual spraying in combination with insecticide-treated nets compared to insecticide-treated nets alone for protection against malaria: a cluster randomised trial in Tanzania. PLoS Med 11: e1001630. [Google Scholar]
  9. Kafy H, , 2013. Combination of IRS with LLINs Versus LLINS Alone in Sudan: Results of a Very Large Randomized Trial (Abstract). 6th MIM Pan-African Malaria Conference, October 6–11, 2013, Durban, South Africa.
  10. Hamainza B, Sikaala CH, Moonga HB, Chanda J, Chinula D, Mwenda M, Kamuliwo M, Bennett A, Seyoum A, Killeen GF, , 2016. Incremental impact upon malaria transmission of supplementing pyrethroid-impregnated long-lasting insecticidal nets with indoor residual spraying using pyrethroids or the organophosphate, pirimiphos methyl. Malar J 15: 100. [Google Scholar]
  11. Protopopoff N, 2013. High level of resistance in the mosquito Anopheles gambiae to pyrethroid insecticides and reduced susceptibility to bendiocarb in north-western Tanzania. Malar J 12: 149. [Google Scholar]
  12. Kabula B, 2014. Distribution and spread of pyrethroid and DDT resistance among the Anopheles gambiae complex in Tanzania. Med Vet Entomol 28: 244–252. [Google Scholar]
  13. Kisinza WN, 2017. Multiple insecticide resistance in Anopheles gambiae from Tanzania: a major concern for malaria vector control. Malar J 16: 439. [Google Scholar]
  14. Strode C, Donegan S, Garner P, Enayati AA, Hemingway J, , 2014. The impact of pyrethroid resistance on the efficacy of insecticide-treated bed nets against African anopheline mosquitoes: systematic review and meta-analysis. PLoS Med 11: e1001619. [Google Scholar]
  15. White MT, Conteh L, Cibulskis R, Ghani AC, , 2011. Costs and cost-effectiveness of malaria control interventions—a systematic review. Malar J 10: 337. [Google Scholar]
  16. Verlé P, Lieu TTT, Kongs A, Van Der Stuyft P, Coosemans M, , 1999. Control of malaria vectors: cost analysis in a province of northern Vietnam. Trop Med Int Health 4: 139–145. [Google Scholar]
  17. Guyatt HL, Kinnear J, Burini M, Snow RW, , 2002. A comparative cost analysis of insecticide-treated nets and indoor residual spraying in highland Kenya. Health Policy Plan 17: 144–153. [Google Scholar]
  18. Kroeger A, Ayala C, Lara AM, , 2002. Unit costs for house spraying and bednet impregnation with residual insecticides in Colombia: a management tool for the control of vector-borne disease. Ann Trop Med Parasitol 96: 405–416. [Google Scholar]
  19. Sine J, Colaço R, Frawley H, , 2011. An Economic Analysis of the Costs of Indoor Residual Spraying in 12 PMI Countries, 2008–2010. Research Triangle Park, NC: RTI International.
  20. Abbott M, Johns B, , 2013. PMI IRS Country Programs: Comparative Cost Analysis, August 11, 2011–December 31, 2012. Bethesda, MD: Africa Indoor Residual Spraying (AIRS) Project, Abt Associates Inc.
  21. Goodman CA, Mnzava AEP, Dlamini SS, Sharp BL, Mthembu DJ, Gumede JK, , 2001. Comparison of the cost and cost-effectiveness of insecticide-treated bednets and residual house-spraying in KwaZulu-Natal, South Africa. Trop Med Int Health 6: 280–295. [Google Scholar]
  22. Xu JW, Yang H, Yang ZQ, Yang GC, Ma XW, Wang WR, Gu YA, Wang LB, Yang XW, Ma J, , 2002. Cost-effectiveness analysis of the current measures for malaria prevention in Yuanjiang valley, Yunnan province [in Chinese]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 20: 238–241. [Google Scholar]
  23. Bhatia MR, Fox-Rushby J, Mills A, , 2004. Cost-effectiveness of malaria control interventions when malaria mortality is low: insecticide-treated nets versus in-house residual spraying in India. Soc Sci Med 59: 525–539. [Google Scholar]
  24. Conteh L, Sharp BL, Streat E, Barreto A, Konar S, , 2004. The cost and cost-effectiveness of malaria vector control by residual insecticide house-spraying in southern Mozambique: a rural and urban analysis. Trop Med Int Health 9: 125–132. [Google Scholar]
  25. Yukich JO, 2008. Costs and consequences of large-scale vector control for malaria. Malar J 7: 258. [Google Scholar]
  26. Tanzania Commission for AIDS, Zanzibar AIDS Commission, National Bureau of Statistics, Office of Chief Government Statistician, ICF International, 2013. Tanzania HIV/AIDS and Malaria Indicator Survey 2011–12. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, and ICF International.
  27. Mulligan JA, Yukich J, Hanson K, , 2008. Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets. Malar J 7: 32. [Google Scholar]
  28. Kolaczinski J, Hanson K, , 2006. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology. Malar J 5: 37. [Google Scholar]
  29. Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, Murray CJL, , 2003. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Geneva, Switzerland: World Health Organization.
  30. Bureau of Economic Analysis, 2018. National Economic Accounts. Available at: http://www.bea.gov/national/index.htm. Accessed April 9, 2018.
  31. UNICEF, 2014. Long Lasting Insecticidal Nets Price Data. Available at: http://www.unicef.org/supply/files/LLINs_price_transparency_2006_-_2014.pdf. Accessed April 9, 2018.
  32. Fullman N, Burstein R, Lim SS, Medlin C, Gakidou E, , 2013. Nets, spray or both? The effectiveness of insecticide-treated nets and indoor residual spraying in reducing malaria morbidity and child mortality in sub-Saharan Africa. Malar J 12: 62. [Google Scholar]
  33. Sicuri E, Vieta A, Lindner L, Constenla D, Sauboin C, , 2013. The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya. Malar J 12: 307. [Google Scholar]
  34. Kleinschmidt I, Schwabe C, Shiva M, Segura JL, Sima V, Mabunda SJ, Coleman M, , 2009. Combining indoor residual spraying and insecticide-treated net interventions. Am J Trop Med Hyg 81: 519–524. [Google Scholar]
  35. Yakob L, Dunning R, Yan G, , 2011. Indoor residual spray and insecticide-treated bednets for malaria control: theoretical synergisms and antagonisms. J R Soc Interface 8: 799–806. [Google Scholar]
  36. Okumu FO, Moore S, , 2011. Combining indoor residual spraying and insecticide-treated nets for malaria control in Africa: a review of possible outcomes and an outline of suggestions for the future. Malar J 10: 208. [Google Scholar]
  37. de Savigny D, Webster J, Agyepong IA, Mwita A, Bart-Plange C, Baffoe-Wilmot A, Koenker H, Kramer K, Brown N, Lengeler C, , 2012. Introducing vouchers for malaria prevention in Ghana and Tanzania: context and adoption of innovation in health systems. Health Policy Plan 27 (Suppl 4): iv32–iv43. [Google Scholar]
  38. UNICEF, 2018. Long Lasting Insecticidal Nets Price Data. Available at: https://www.unicef.org/supply/files/LLINs_Pricing_2018.pdf. Accessed April 13, 2018.
  39. President’s Malaria Initiative, Tanzania Malaria Operational Plan FY18, 2017. Available at: https://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-2018/fy-2018-tanzania-malaria-operational-plan.pdf?sfvrsn=5. Accessed December 6, 2017.
  40. Asenso-Okyere K, Asante FA, Tarekegn J, Andam KS, , 2011. A review of the economic impact of malaria in agricultural development. Agric Econ 42: 293–304. [Google Scholar]
  41. Njama-Meya D, Kamya MR, Dorsey G, , 2004. Asymptomatic parasitaemia as a risk factor for symptomatic malaria in a cohort of Ugandan children. Trop Med Int Health 9: 862–868. [Google Scholar]
  42. Mabunda S, Aponte JJ, Tiago A, Alonso P, , 2009. A country-wide malaria survey in Mozambique. II. Malaria attributable proportion of fever and establishment of malaria case definition in children across different epidemiological settings. Malar J 8: 74. [Google Scholar]
  43. Strøm GEA, Tellevik MG, Fataki M, Langeland N, Blomberg B, , 2013. No asymptomatic malaria parasitaemia found among 108 young children at one health facility in Dar es Salaam, Tanzania. Malar J 12: 417. [Google Scholar]
  44. Mutabingwa TK, Anthony D, Heller A, Hallett R, Ahmed J, Drakeley C, Greenwood BM, Whitty CJM, , 2005. Amodiaquine alone, amodiaquine+sulfadoxine-pyrimethamine, amodiaquine+artesunate, and artemether-lumefantrine for outpatient treatment of malaria in Tanzanian children: a four-arm randomised effectiveness trial. Lancet 365: 1474–1480. [Google Scholar]
  45. Shayo A, Mandara CI, Shahada F, Buza J, Lemnge MM, Ishengoma DR, , 2014. Therapeutic efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in north-eastern Tanzania. Malar J 13: 376. [Google Scholar]
  46. Gonçalves BP, Huang CY, Morrison R, Holte S, Kabyemela E, Prevots R, Fried M, Duffy PE, , 2014. Parasite burden and severity of malaria in Tanzanian children. N Engl J Med 370: 1799–1808. [Google Scholar]
  47. Guyatt HL, Corlett SK, Robinson TP, Ochola SA, Snow RW, , 2002. Malaria prevention in highland Kenya: indoor residual house-spraying vs. insecticide-treated bednets. Trop Med Int Health 7: 298–303. [Google Scholar]
  48. Yukich J, Mulligan J, Tediosi F, Hanson K, Lengeler C, , 2007. Tanzania: costing and cost-effectiveness. Yukich J, Tediosi F, Lengeler C, eds. 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). Basel, Switzerland: Swiss Tropical Institute, 47–64.
  49. Grabowsky M, 2005. Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage. Bull World Health Organ 83: 195–201. [Google Scholar]
  50. Yukich J, 2007. Senegal: costing and cost-effectiveness. Yukich J, Tediosi F, Lengeler C, eds. 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). Basel, Switzerland: Swiss Tropical Institute, 83–9.
  51. Kolaczinski JH, Kolaczinski K, Kyabayinze D, Strachan D, Temperley M, Wijayanandana N, Kilian A, , 2010. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda. Malar J 9: 102. [Google Scholar]
  52. Becker-Dreps SI, Biddle AK, Pettifor A, Musuamba G, Imbie DN, Meshnick S, Behets F, , 2009. Cost-effectiveness of adding bed net distribution for malaria prevention to antenatal services in Kinshasa, Democratic Republic of the Congo. Am J Trop Med Hyg 81: 496–502. [Google Scholar]
  53. De Allegri M, Marschall P, Flessa S, Tiendrebéogo J, Kouyaté B, Jahn A, Müller O, , 2010. Comparative cost analysis of insecticide-treatment net delivery strategies: sales supported by social marketing and free distribution through antenatal care. Health Policy Plan 25: 28–38. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0537
Loading
Cost-Effectiveness of Indoor Residual Spraying of Households with Insecticide for Malaria Prevention and Control in Tanzania
The American Journal of Tropical Medicine and Hygiene 99, 627 (2018); https://doi.org/10.4269/ajtmh.17-0537
/content/journals/10.4269/ajtmh.17-0537
/content/journals/10.4269/ajtmh.17-0537
Loading

Data & Media loading...

Supplemental files and tables

  • Supplementary File

Download
Download
Download
  • Received : 06 Jul 2017
  • Accepted : 17 May 2018
  • Published online : 16 Jul 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error