Cost-Effectiveness of Focal Mass Drug Administration and Mass Drug Administration with Dihydroartemisinin–Piperaquine for Malaria Prevention in Southern Province, Zambia: Results of a Community-Randomized Controlled Trial
Joshua Yukich, Callie A. Scott, Kafula Silumbe, Bruce A. Larson, Adam Bennett, Timothy P. Finn, Busiku Hamainza, Ruben Conner, Travis R. Porter, Joseph Keating, Richard W. Steketee, Thomas P. Eisele, John M. Miller
Abstract
= 0.87), but that MDA was superior in all cost-effectiveness measures, including cost per infection averted, cost per case averted, cost per death averted, and cost per disability-adjusted life year averted. Subsequent costing of the MDA intervention in a non-trial, operational setting yielded significantly lower costs per person reached (US$2.90). Mass drug administration with DHAp also met the WHO thresholds for "cost-effective interventions" in the Zambian setting in 90% of simulations conducted using a probabilistic sensitivity analysis based on trial costs, whereas fMDA met these criteria in approximately 50% of simulations. A sensitivity analysis using costs from operational deployment and trial effectiveness yielded improved cost-effectiveness estimates. Mass drug administration may be a cost-effective intervention in the Zambian context and can help reduce the parasite reservoir substantially. Mass drug administration was more cost-effective in relatively higher transmission settings. In all scenarios examined, the cost-effectiveness of MDA was superior to that of fMDA.