Cost Effectiveness of Intermittent Preventive Treatment of Malaria in Infants in Ghana
Anselm Komla Abotsi *
Social Science Department, University of Education, P. O. Box 25, Winneba, Ghana
Ebenezer Inkoom
Inkoom Hospital, P. O. Box 288, Nsawam, Ghana
Eric Ribaira
UNICEF, P. O. Box 4884, Pretoria, South Africa
Rozenn Le Mentec
European Agency for the Development and Health (AEDES), Madagascar
Pierre Levy
Université Paris-Dauphine, Place du Maréchal de Lattre de Tassigny-75775, PARIS Cedex 16, France
Herve Lafarge
Université Paris-Dauphine, Place du Maréchal de Lattre de Tassigny-75775, PARIS Cedex 16, France
Alexandra de Sousa
UNICEF West and Central Africa Regional Office (WCARO), P.O. Box 29 720, Yoff, Dakar, Senegal
*Author to whom correspondence should be addressed.
Abstract
Aim: In order to integrate malaria Intermittent Preventive Treatment in infants (IPTi) into the Ghana national immunization programme, there was the need to evaluate the feasibility of IPTi by assessing the intervention operational issues including its implementation costs, and its cost effectiveness.
Study Design: Cross-sectional study.
Place and Duration of Study: Upper East Region, Ghana, between July 2007 and July 2009
Methods: We calculated the costs of administrating IPTi during vaccination sessions; the costs of programme implementation during the first year of implementation (start-up costs) and in routine years (recurrent costs). For the purposes of cost-effectiveness analysis, all economic costs (including financial and opportunity costs) and the net cost were estimated. To estimate the cost effectiveness ratios of IPTi, the aggregate cost of providing the intervention for a reference target population of 1,000 infants was divided by its health outcome. Sensitivity analyses were carried out to understand the results robustness.
Results: IPTi gross costs in start up and in routine years were estimated at 70.66 cents and 29.72 cents per dose, or $2.0 and $0.87 per infant, respectively. The gross cost per DALY saved was estimated at $3.49 and the net cost of IPTi for 1,000 infants was $-3,416.38 in the routine years rending IPTi a highly cost saving intervention. Sensitivity analyses showed that the cost per DALY saved never went up more than $4.50 maintaining the intervention still highly cost effective.
Conclusion: IPTi in Ghana is a highly and robust cost effective intervention. The intervention is cost-saving and should be scaled up nationally to save children’s health and economic capital.
Keywords: Malaria, intermittent preventive treatment in infants, health outcome, direct delivery cost, indirect delivery cost, economic cost, incremental costs, cost effectiveness analysis