National Project Implementation Plan - NVBDCP

Chapter 14
Economic and Financial Analysis
14.1 Economic Analysis
The project seeks to reduce malaria burden in selected, highly endemic areas
as well as eliminate kala-azar. This project supports certain very important
interventions such as the introduction of a new diagnosis and treatment
protocol, strengthening service delivery mechanisms which are necessary for
the effective implementation of the new protocol, a different strategy for
effective surveillance, strong emphasis on the availability and use of long
lasting insecticidal nets for vector control and so forth. The known interventions
in both these diseases are highly cost-effective.
Available evidence suggests that all malaria interventions are highly attractive
(cost-effective) using a cutoff of US$150 per DALY averted.18 There are two
broad types of interventions in Malaria control: case management and
prevention. On the prevention side, the review of worldwide trials of ITNs and
IRS by Curtis and Mnzava’s suggests that ITNs and IRS have equivalent
effectiveness. Similar conclusion is reached also by Lengeler and Sharp (2003)
who notes that choosing between IRS and ITNs is “largely a matter of
operational feasibility and availability of local resources than one of malaria
epidemiology or cost-effectiveness.” Given cost-effectiveness of both the
strategies, choice between ITNs and IRS then essentially reduces to operational
and logistical challenges in a given context.
A number of studies from Sub-Sahara Africa, particularly, in the Gambia,
Ghana, and Kenya have shown the provision and insecticide treatment of bed
nets to be highly cost-effective under varying conditions.19 A study by
Goodman et al. (2001) compared the cost and cost-effectiveness of insecticidetreated
bednets and IRS KwaZulu-Natal in South Africa. The study concludes,
“In view of the greater effectiveness of ITBN, policy makers may view ITBN as
a cost-effective use of resources, even if the economic costs are higher.”20
18 Breman, J.G. et al, Conquering malaria, Chapter 21 in Disease Control Priorities in Developing
Countries 2006, pages 413-432.
19 Goodman CA., and Mills AJ, (1999), The evidence base on the cost-effectiveness of malaria
control measures in Africa, Health Policy and Planning, Review Article, 14(4): 301–312.
20 Goodman CA., et al. (2001), Comparison of the cost and cost-effectiveness
of insecticide-treated bednets and residual house-spraying in KwaZulu-Natal, South Africa Tropical
Medicine and International Health, Volume 6, No. 4, pp 280-295 April 2001.
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