Modelling the returns on options for improving malaria case management in Ethiopia

Area of Science:

• Global Health
• Public Health Policy
• Health Economics

Background:

• Debate exists on optimal strategies for scaling up malaria interventions.
• Key controversies include target scope (febrile illness vs. malaria), intervention approach (single vs. targeted), and delivery mechanism.

Purpose of the Study:

• To evaluate the cost-effectiveness of different strategies for scaling up interventions for childhood febrile illness in Ethiopia.
• To compare bundled interventions for malaria and pneumonia against baseline management.

Main Methods:

• A decision model with 576 nodes was developed to simulate access, treatment, and outcomes for febrile illness episodes in children under 5.
• Incremental costs and outcomes were computed from a societal and financier perspective using literature data.

Main Results:

• Scaling up interventions is highly cost-effective for saving young lives in low-income countries.
• Bundling malaria and pneumonia interventions for febrile illness, including rapid diagnostic tests and antibiotics, saves tens of thousands of lives at a lower societal cost than baseline management.
• Community health worker delivery offers broader coverage but may have limited effectiveness compared to facility-based approaches.

Conclusions:

• Integrated management of childhood febrile illness, including malaria and pneumonia, presents a highly cost-effective strategy for reducing child mortality.
• Policy decisions should consider the trade-offs between intervention scope, targeting, and delivery mechanisms for optimal impact.