Cost-Utility Analysis of Community Case Management for Malaria Control in Burundi

Area of Science:

• Public Health
• Health Economics
• Malariology

Background:

• Malaria remains a significant public health concern in Burundi, particularly affecting children under five.
• The community case management (CCM) program is a key strategy for malaria control, aiming to improve access to treatment.
• This study evaluates the economic impact of integrating CCM with existing health facility management (HFM).

Purpose of the Study:

• To compare the cost-effectiveness and utility of combined CCM and HFM versus HFM alone for pediatric malaria control in Burundi.
• To inform resource allocation decisions for malaria control programs in Burundi.

Main Methods:

• A five-year Markov model with one-week cycles was constructed to simulate disease progression and recurrent malaria.
• Cost data were collected empirically for 2019, and analyses included incremental cost per disability-adjusted life year (DALY) averted.
• One-way and probabilistic sensitivity analyses (PSAs) were performed to assess model robustness.

Main Results:

• Combining CCM with HFM was found to be more cost-effective from both provider and societal perspectives.
• The addition of CCM, using artesunate amodiaquine (ASAQ) or Artemether Lumefantrine (AL), resulted in a modest increase in cost per DALY averted.
• At a willingness-to-pay of one GDP/capita, the CCM program demonstrated a 100% probability of being cost-effective.

Conclusions:

• The integrated CCM and HFM approach represents value for money for malaria control in Burundi.
• Findings support decision-makers in Burundi regarding resource allocation for scaling up malaria control programs.
• The study highlights the economic benefits of community-based interventions in endemic regions.