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Cost of Community-Led Larval Source Management and House Improvement for Malaria Control: A Cost Analysis Within A Cluster-Randomised Trial in A Rural District in Malawi
Mphatso Dennis Phiri
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4072-9715
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a factorial design trial, in addition to standard national malaria control interventions in Chikwawa district, southern Malawi.
Methods: In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis larvicide application, while HI involved closing of eaves and gaps on walls, and screening windows and ventilation spaces with wire mesh. Communities implemented all interventions. Costs were estimated retrospectively using the ‘ingredients approach’, combining both ‘bottom-up’ and ‘top-down approaches’, from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI only, LSM only and HI+LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored.
Results: The total economic program costs of community-led HI and LSM implementation was $626,152. Economic implementation costs of HI, LSM and HI+LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Estimated costs were sensitive to changes in staff costs and population covered.
Conclusions: In the context of the trial, the economic costs of community-led HI and LSM implementation were high compared to conventional vector control interventions. Several factors, including the year-round implementation of LSM and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which may limit generalisability of estimated costs where different designs are used. Nevertheless, costs may inform planners of future similar intervention packages.
Trial registration: Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.
Keywords
Malaria, cost analysis, house improvement, larval source management, community-led
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This is a list of supplementary files associated with this preprint. Click to download.
- PhiriMDAdditionalFileS1.docx
Additional File S1.docx: Staff structure, roles and time spent on intervention implementation of trial interventions.
- PhiriMDAdditionalFileS2.docx
Additional File S2.docx: Resource consumption shares for each trial intervention arm used to develop cost allocation proxies
- PhiriMDAdditionalFileS3.docx
Additional File S3.docx: Inflation, exchange and annualisation factors
- PhiriMDAdditionalFileS4.docx
Additional File S4.docx: Tornado graphs and sensitivity analysis of the mean cost per person for larval source management alone arm and house improvement plus larval source management arm.
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Received 12 Jan, 2021
Reviewer #2 agreed
On 23 Dec, 2020
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On 17 Dec, 2020
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This preprint is under consideration at Malaria Journal. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Cost of Community-Led Larval Source Management and House Improvement for Malaria Control: A Cost Analysis Within A Cluster-Randomised Trial in A Rural District in Malawi
Mphatso Dennis Phiri
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4072-9715
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Dec, 2020
No community comments so far
Review #1 received
Received 12 Jan, 2021
Reviewer #2 agreed
On 23 Dec, 2020
Reviewers invited
Invitations sent on 23 Dec, 2020
Reviewer #1 agreed
On 23 Dec, 2020
Editor assigned
On 17 Dec, 2020
Submission checks complete
On 17 Dec, 2020
Editor invited
On 17 Dec, 2020
First submitted
On 16 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a factorial design trial, in addition to standard national malaria control interventions in Chikwawa district, southern Malawi.
Methods: In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis larvicide application, while HI involved closing of eaves and gaps on walls, and screening windows and ventilation spaces with wire mesh. Communities implemented all interventions. Costs were estimated retrospectively using the ‘ingredients approach’, combining both ‘bottom-up’ and ‘top-down approaches’, from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI only, LSM only and HI+LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored.
Results: The total economic program costs of community-led HI and LSM implementation was $626,152. Economic implementation costs of HI, LSM and HI+LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Estimated costs were sensitive to changes in staff costs and population covered.
Conclusions: In the context of the trial, the economic costs of community-led HI and LSM implementation were high compared to conventional vector control interventions. Several factors, including the year-round implementation of LSM and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which may limit generalisability of estimated costs where different designs are used. Nevertheless, costs may inform planners of future similar intervention packages.
Trial registration: Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.
Figure 1
Figure 2
Figure 3
Figure 4