Introduction
Materials and methods
Selection and sites of the study
Sampling and data collection
Method of calculating cost-effectiveness ratios
-
Estimated cost of implementation of the IRS
-
Estimation of the cost of distribution of LLINs
-
Estimation of cost savings for the health care facility (S1):
Estimation of cost savings by patient/community (S2)
Data analysis
Ethical approval
Results
Estimation of the differential effectiveness
Estimated cost of the intervention
Municipalities | Number of LLINs distributed | Unit purchase cost of LLINs | Total cost of LLINs bought (FCFA) | Other fees (transport/distribution cost) (FCFA) | Total (FCFA) | Cost /LLINs distributed (FCFA) |
---|---|---|---|---|---|---|
COPARGO
| 13,017 | 2,755 | 35,860,687 | 436,666 | 36,297,353 | 2,788.5 |
GUILMARO
| 12,151 | 2,755 | 33,474,628 | 724,562 | 34,199,189 | 2,814.6 |
KOUANDE
| 14,183 | 2,755 | 39,074,088 | 702,527 | 39,776,615 | 2,804.5 |
PABEGOU
| 6,951 | 2,755 | 19,149,546 | 371,368 | 19,520,913 | 2,808.4 |
Estimation of resources saved by health care facility (S1)
Municipalities | Type of malaria | Number of cases one year before (E1) | Number of cases one year after (E2) | Differential effectiveness (E) (E1 – E2) |
---|---|---|---|---|
COPARGO | Uncomplicated | 2,056 | 1,805 | 251 |
Severe | 415 | 315 | 100 | |
GUILMARO | Uncomplicated | 1,283 | 891 | 392 |
Severe | 94 | 78 | 16 | |
KOUANDE | Uncomplicated | 1,721 | 486 | 1,235 |
Severe | 256 | 104 | 152 | |
PABEGOU | Uncomplicated | 3,399 | 2,342 | 1,057 |
Severe | 157 | 134 | 23 |
Management of malaria step and key personal used | Uncomplicated malaria | Severe malaria | ||||||
---|---|---|---|---|---|---|---|---|
Kouandé Centre | Guilmaro | Kouandé-Centre | Guilmaro | |||||
Duration (mn) | Cost (FCFA) | Duration (mn) | Cost (FCFA) | Duration (mn) | Cost (FCFA) | Duration (mn) | Cost (FCFA) | |
Reception
| ||||||||
AS | 15 | 111.6 | 10 | 74.4 | 15 | 111.6 | 10 | 74.4 |
IS (nurse assistant) | ||||||||
Consultation
| ||||||||
Doctor/Gynaecologist | 15 | 461.4 | 15 | 461.4 | ||||
Nurse/Midwife | 15 | 195.5 | 15 | 195.5 | ||||
IS (Nurse assistant) | ||||||||
Diagnostic confirmation
| ||||||||
AS of levy | 10 | 74.4 | 10 | 74.4 | ||||
TSL | 45 | 736.9 | 45 | 736.9 | ||||
Treatment
| ||||||||
Nurse /Midwife | 5 | 65.2 | 5 | 65.2 | 49.5 | 645.1 | ||
AS (carer) | 49.5 | 368.2 | ||||||
Pharmacy
| ||||||||
AS/Commis (carer) | 5 | 37.2 | 5 | 37.2 | 10 | 37.2 | 5 | 52.1 |
Hospitalization
| ||||||||
Doctor | 30 | 922.8 | ||||||
Nurse/Midwife | 4,320 | 56,295.39 | ||||||
AS | 4,320 | 32,137.04 | ||||||
TOTAL
|
MOD = 1,486.7
|
MOD = 307.1
|
MOD = 88,432.4
|
MOD = 1,335.3
|
Management of malaria step and key personal used | Uncomplicated malaria | Severe malaria | ||||||
---|---|---|---|---|---|---|---|---|
Copargo-Centre | Pabégou | Copargo-Centre | Pabégou | |||||
Duration (mn) | Cost (FCFA) | Duration (mn) | Cost (FCFA) | Duration (mn) | Cost (FCFA) | Duration (mn) | Cost (FCFA) | |
Reception
| ||||||||
AS (carer) | 15 | 111.6 | 10 | 74.4 | 15 | 111.6 | 10 | 74.4 |
IS | ||||||||
Consultation
| ||||||||
Doctor/Gynecologist | 15 | 461.4 | 15 | 461.4 | ||||
Nurse/SFE | 15 | 146.5 | 15 | 195.5 | ||||
IS (nurse assistant) | ||||||||
Diagnostic confirmation
| ||||||||
AS of levy | 10 | 74.4 | 10 | 74.4 | ||||
TSL | 45 | 736.9 | 45 | 736.9 | ||||
Treatment
| ||||||||
Nurse /Midwife | 5 | 65.2 | 8 | 104.3 | 81.5 | 795.8 | ||
AS (carer) | 8 | 59.5 | 81.5 | 606.3 | ||||
Pharmacy
| ||||||||
AS/Commis | 5 | 37.2 | 5 | 37.2 | 10 | 37.2 | 5 | 52.1 |
Hospitalization
| ||||||||
Doctor | 30 | 922.8 | ||||||
Nurse/Midwife | 4,320 | 28,147.7 | ||||||
AS | 4,320 | 16,068.5 | ||||||
TOTAL
|
MOD = 1,486.7
|
MOD = 258.1
|
MOD = 46,724.2
|
MOD = 1,724.1
|
Municipalities | Number of uncomplicated malaria cases averted | Cost of the MOD for uncomplicated malaria case | Number of severe malaria cases averted | MOD cost for severe malaria case (FCFA) | Cost savings for health providers (FCFA) |
---|---|---|---|---|---|
(a) | (b) | (c) | (d) | (a*b) + (c*d) | |
Copargo Centre | 251.0 | 1,486.7 | 100 | 46,724.2 | 5,045,581.7 |
Guilmaro | 392.0 | 307.1 | 16.0 | 1,335.3 | 141,748.0 |
Kouandé Centre | 1,235.0 | 1,486.7 | 152.0 | 88,432.4 | 15,277,799.0 |
Pabégou | 1,057.0 | 258.0 | 23.0 | 1,724.1 | 312,466.0 |
Estimation of resources saved by households (S2)
Municipalities | Number of uncomplicated malaria cases averted | Average economic cost per uncomplicated malaria case | Number of severe malaria cases prevented | Average economic cost per severe malaria case | Cost savings by household |
---|---|---|---|---|---|
(a) | (b) | (c) | (d) | (a*b) + (c*d) | |
Copargo Centre | 251.0 | 1486.7 | 100 | 46,724.2 | 5,045,581.7 |
Guilmaro | 392.0 | 307.1 | 16.0 | 1,335.3 | 141,748.0 |
Kouandé Centre | 1,235.0 | 1,486.7 | 152.0 | 88,432.4 | 15,277,799.0 |
Pabégou | 1,057.0 | 258.0 | 23.0 | 1,724.1 | 312,466.0 |
Calculation of cost-effectiveness ratios by municipality
Type of zone | Boroughs | Population protected (a) | Cost per person protected (b) | Number of LLINs distributed (c) | Cost per LLINs distributed (d) | Cost savings for health providers (S1) | Cost savings for the communities (S2) | C Intv [((a*b)+(c*d))-(S1+S2)] | Number of malaria cases prevented (E) | Cost effectiveness ratio (CE) |
---|---|---|---|---|---|---|---|---|---|---|
Urban
| Copargo-centre | - | 2 000 | 13 017 | 2 788,5 | 5 045 582 | 1 216 396,5 | 30 035 926 | 351 |
85 572,4
|
Kouandé-centre | 27 316,0 | 2 000 | 14 183 | 2 804,5 | 15 277 799 | 25 130 876,3 | 53 999 548 | 1 387 |
38 932,6
| |
Rural
| Pabégou | - | 2 000 | 6 951 | 2 808,4 | 312 466 | 1 992 917,7 | 17 215 805 | 1 080 |
15 940,6
|
Guilmaro | 19 188,0 | 2 000 | 12 151 | 2 814,6 | 141 748 | 1 145 220,8 | 71 289 236 | 408 |
174 728,5
|
Sensitivity analysis
Urban zone | Rural zone | |||
---|---|---|---|---|
Copargo Centre (LLINs) | Kouandé Centre (LLINs + IRS) | Pabégou (LLINs) | Guilmaro (LLINs + IRS) | |
CE Ratio in function of RR CI 95% | RR = 0.25 [0.223;0.279] | RR = 0.22 [0.208;0.240] | ||
Cost -effectiveness Ratio if RR = lower limit | 79,753.5 | 36,285.2 | 15,071.1 | 165,197.9 |
Cost -effectiveness Ratio if RR = average value | 85,572.4 | 38,932.4 | 15,940.6 | 174,728.5 |
Cost -effectiveness Ratio if RR = upper limit | 95,498.8 | 43,448.8 | 17,389.7 | 190,612.9 |
Discussion
Limitations of the study
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from an epidemiological point of view, it would have been interesting to have confirmation of the rate of diagnosis of malaria (TDR/GE) in the monthly reporting of malaria cases recorded in health facilities. It is not very low and is close to 80% per site. A bigger screening study (TDR) at community level would have strengthened the epidemiological results;
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from an economic point of view, the fact that the cost calculation is based on the history of the patient, and documents which mainly concern the patient’s experience of the disease could lead to a bias in the quality of the information received;
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the expenditure saved by providers has been underestimated, because it was not possible to specify the exact quantities of inputs used and the estimate of cost for the very basic medical equipment.