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Papers Achieving the millennium development goals for health

Cost effectiveness analysis of strategies to combat malaria in developing countries

BMJ 2005; 331 doi: (Published 01 December 2005) Cite this as: BMJ 2005;331:1299

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  1. Chantal M Morel (Chantal.Morel{at}, research fellow1,
  2. Jeremy A Lauer, economist2,
  3. David B Evans, director3
  1. 1 Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2 Costs, Effectiveness, Expenditure and Priority Setting Team, Health Systems Financing Department, World Health Organization, Geneva, Switzerland
  3. 3 Health Systems Financing Department, World Health Organization
  1. Correspondence to: C M Morel
  • Accepted 12 October 2005


Objective To determine the cost effectiveness of selected malaria control interventions in the context of reaching the millennium development goals for malaria.

Design Generalised cost effectiveness analysis.

Data sources Efficacy data came from the literature and authors' calculations supported by expert opinion. Quantities for resource inputs came from the literature and from expert opinion; prices came from the WHO-CHOICE database.

Methods Costs were assessed in year 2000 international dollars, and effects were assessed as disability adjusted life years averted by a 10 year implementation programme. Analysis was restricted to sub-Saharan regions where the most deadly form of malaria, Plasmodium falciparum, is most prevalent. The impact on population health for various interventions, and their combinations, was evaluated at selected coverage levels by using a state-transition model. Sensitivity analysis was done for age weights and discounting.

Results High coverage with artemisinin based combination treatments was found to be the most cost effective strategy for control of malaria in most countries in sub-Saharan Africa.

Conclusions A much larger infusion of resources than those currently available is needed to make headway in the fight to roll back malaria. On cost effectiveness grounds, in most areas in sub-Saharan Africa greater coverage with highly effective combination treatments should be the cornerstone of malaria control. However, treatment alone can achieve less than half the total benefit obtainable through a combination of interventions—scaling up the use of impregnated mosquito nets or indoor spraying with insecticides is also critical. Intermittent presumptive treatment of pregnant women can bring a small but important additional health gain at relatively low cost.

This article is part of a series examining the cost effectiveness of strategies to achieve the millennium development goals for health


  • Embedded Image Extra tables and figures and an appendix are on

  • Contributors CMM and JAL contributed equally to the planning, conduct, interpretation, and writing up of the work. CMM was responsible for assessing and estimating all malaria specific data and methods; JAL was responsible for the final estimation and modelling of costs and effects at population level. DBE revised the analysis plan and contributed critical interpretive content. All authors revised and approved the final draft. JAL is the guarantor.

  • Funding CMM received consulting fees from the World Health Organization. The views expressed are solely those of the authors and do not necessarily reflect the decisions or stated policy of the London School of Hygiene and Tropical Medicine or the World Health Organization.

  • Competing interests None declared.

  • Accepted 12 October 2005
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