ArticleCost effectiveness and resource allocation : C/E2018
Cost-effectiveness of a combined intervention of long lasting insecticidal nets and indoor residual spraying compared with each intervention alone for malaria prevention in Ethiopia.
Article in Cost effectiveness and resource allocation : C/E, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
15 citing papers in PubMed, 6 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Health-related quality of life due to malaria: a systematic review.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2025Pooled it
- Strategic resource allocation for malaria elimination in endemic settings: a systematic review of cost-effectiveness evidence.Frontiers in public health · 2025Pooled it
- Characteristics and Quality Appraisal of the Economic Evaluations Done in Ethiopia: A Systematic Review.PharmacoEconomics - open · 2023Pooled it
- A systematic review of scope and quality of health economic evaluations conducted in Ethiopia.Health policy and planning · 2022Pooled it
- Indoor residual spraying for preventing malaria in communities using insecticide-treated nets.The Cochrane database of systematic reviews · 2022Pooled it
- Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2021Pooled it
- Cost-effectiveness of outdoor residual spraying, insecticide-treated nets, and their combination for zoonotic malaria control in Sabah, Malaysia: a comparative analysis.Malaria journal · 2026Article
- Perceptions and practices of household heads toward malaria: a community based cross sectional study in Southwest Ethiopia.Malaria journal · 2025Article
- A geo-enabled digital tool for microplanning and delivery of indoor residual spray in Zambia: A case study, 2016-2020.PLOS global public health · 2025Article
- High impact health service interventions for attainment of UHC in Africa: A systematic review.PLOS global public health · 2022Article
- Cost and cost-effectiveness of indoor residual spraying with pirimiphos-methyl in a high malaria transmission district of Mozambique with high access to standard insecticide-treated nets.Malaria journal · 2021Article
- Incremental impact on malaria incidence following indoor residual spraying in a highly endemic area with high standard ITN access in Mozambique: results from a cluster-randomized study.Malaria journal · 2021Article
- Generalised cost-effectiveness analysis of 159 health interventions for the Ethiopian essential health service package.Cost effectiveness and resource allocation : C/E · 2021Article
- A cost analysis to address issues of budget constraints on the implementation of the indoor residual spray programme in two districts of Maputo Province, Mozambique.Malaria journal · 2021Article
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Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe effectiveness of long lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), for malaria prevention, have been established in several studies. However, the available evidence about the additional resources required for a combined implementation (LLIN + IRS) with respect to the added protection afforded is limited. Therefore, the aim of this study was to compare the cost-effectiveness of combined implementation of LLINs and IRS, compared with LLINs alone, IRS alone, and routine practice in Ethiopia.
methodsThe study was performed alongside a cluster randomized controlled trial of malaria prevention conducted in Adami Tullu district, in Ethiopia, from 2014 to 2016. In addition, literature-based cost-effectiveness analysis-using effectiveness information from a systematic review of published articles was conducted. Costing of the interventions were done from the providers' perspective. The health-effect was measured using disability adjusted life years (DALYs) averted, and combined with cost information using a Markov life-cycle model. In the base-case analysis, health-effects were based on the current trial, and in addition, a scenario analysis was performed based on a literature survey.
resultsThe current trial-based analysis showed that routine practice is not less effective and therefore dominates both the combined intervention and singleton intervention due to lower costs. The literature-based analysis had shown that combined intervention had an incremental cost-effectiveness ratio of USD 1403 per DALY averted, and USD 207 per DALY averted was estimated for LLIN alone. In order for the ICER for the combined intervention to be within a range of 1 GDP per capita per DALY averted, the annual malaria incidence in the area should be at least 13%, and the protective-effectiveness of combined implementation should be at least 53%.
conclusionsBased on the current trial-based analysis, LLINs and IRS are not cost-effective compared to routine practice. However, based on the literature-based analysis, LLIN alone is likely to be cost-effective compared to 3 times GDP per capita per DALY averted. The annual malaria probability and protective-effectiveness of combined intervention are key determinants of the cost-effectiveness of the interventions.
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