National Project Implementation Plan - NVBDCP

diagnosis and treatment, causing substantial emotional and economic hardship
for affected families (Ahluwalia et al 2003).23
With effective case management it is possible to eliminate kala azar, and case
management is more cost-effective than vector control. Recent studies24 show
kala azar treatment to be extremely cost-effective as it costs US$315 per death
averted and US$9 per DALY gained.25
To gain a perspective on cost-effectiveness of malaria and kala azar
interventions we present cost-effectiveness of a few comparators. Improved
case management and immunization (currently undergoing clinical trials) for
dengue costs US$ 587 to US$ 1440 per DALY averted. Similarly, among
interventions against diarrheal disease during the first year of life, oral
dehydration therapy costs US$ 132 to US$ 2570 per DALY averted and cholera
immunizations costs US$ 1658 to US$ 8274 per DALY averted. Malaria and kala
azar interventions, in comparison, are highly cost effective.
A small exercise on cost-effectiveness of introducing ACT using Indian data
suggests that under the proposed policy, the unit cost of both diagnosis and
treatment will be over ten-fold higher than that of current policy (Rs.7.5 vs. Rs.
77.8). Even though the new protocol may appear to be expensive, the real
benefits accrue in terms of reduced transmission and reduced mortality. The
steep reduction in hospitalizations and mortality as well as the reduction in
transmission (as seen in other parts of the world) will more than compensate
for the initial increase in costs. With the estimated reduction in transmission,
after five years of implementation, the cost of the new policy will only be
around 68% more than the current policy (Rs. 1073 million vs. Rs. 1633 million
in the 100 districts), but will avert around 66,000 estimated hospitalizations
and about 13,200 deaths (see the analysis below).
Cost benefit analysis of switching from the current to the new protocol for the
diagnosis and treatment of malaria
MOHFW/NVBDCP has implemented Artemisinin derivative Combination
Therapy (ACT), in all the World Bank’s 50 project districts and districts under
GFATM. ACTs have high efficacy but are also much more expensive - up to 10-
20 fold. Still, the cost of adopting ACT needs to be assessed and compared with
the cost of current protocol being followed in India. Studies have linked the
23 Ahluwalia I B et al. (2003). Visceral leishmaniasis: consequences of a neglected disease in a
Bangladeshi community. Am. J. Trop. Med. Hyg., 69(6), pp. 624-628.
24 For example, Laxminarayan, R., et al, Intervention Cost-effectiveness: Overview of Main
Messages, Chapter 2 in Disease Control Priorities in Developing Countries 2006, pages 35-86.
25 One DALY (Disability-Adjusted Life Year) represents a lost year of healthy life due to poor health
or disability and potential years of life lost due to premature death.
151