Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK.
Department of Parasitology, Université Cheikh Anta Diop, Dakar, Senegal.
Health Policy Plan. 2017 Nov 1;32(9):1256-1266. doi: 10.1093/heapol/czx084.
Seasonal Malaria Chemoprevention (SMC) is recommended for children under 5 in the Sahel and sub-Sahel. The burden in older children may justify extending the age range, as has been done effectively in Senegal. We examine costs of door-to-door SMC delivery to children up to 10 years by community health workers (CHWs). We analysed incremental financial and economic costs at district level and below from a health service perspective. We examined project accounts and prospectively collected data from 405 CHWs, 46 health posts, and 4 district headquarters by introducing questionnaires in advance and completing them after each monthly implementation round. Affordability was explored by comparing financial costs of SMC to relevant existing health expenditure levels. Costs were disaggregated by administration month and by health service level. We used linear regression models to identify factors associated with cost variation between health posts. The financial cost to administer SMC to 180 000 children over one malaria season, reaching ∼93% of children with all three intended courses of SMC was $234 549 (constant 2010 USD) or $0.50 per monthly course administered. Excluding research-participation incentives, the financial cost was $0.32 per resident (all ages) in the catchment area, which is 1.2% of Senegal's general government expenditure on health per capita. Economic costs were 18.7% higher than financial costs at $278 922 or $0.59 per course administered and varied widely between health posts, from $0.38 to $2.74 per course administered. Substantial economies of scale across health posts were found, with the smallest health posts incurring highest average costs per monthly course administered. SMC for children up to 10 is likely to be affordable, particularly where it averts substantial curative care costs. Estimates of likely costs and cost-effectiveness of SMC in other contexts must account for variation in average costs across delivery months and health posts.
季节性疟疾化学预防（SMC）建议在萨赫勒和萨赫勒以南地区为 5 岁以下儿童使用。对于年龄较大的儿童，其负担可能证明扩大年龄范围是合理的，塞内加尔已经有效地做到了这一点。我们检查了社区卫生工作者（CHW）上门为 10 岁以下儿童提供 SMC 的成本。我们从卫生服务的角度分析了地区和以下各级的增量财务和经济成本。我们检查了项目账目，并通过提前引入问卷，在每个月的实施轮次后完成问卷，从 405 名 CHW、46 个卫生所和 4 个地区总部收集了前瞻性数据。通过将 SMC 的财务成本与相关的现有卫生支出水平进行比较，探讨了可负担性。成本按管理月份和卫生服务级别进行细分。我们使用线性回归模型来确定卫生所之间成本变化的相关因素。在一个疟疾季节为 180000 名儿童管理 SMC 的财务成本为 234549 美元（2010 年不变美元）或每 3 个疗程的 0.50 美元。不包括研究参与激励措施，在集水区内，每个居民（所有年龄）的财务成本为 0.32 美元，占塞内加尔人均卫生总政府支出的 1.2%。经济成本比财务成本高 18.7%，为 278922 美元或每疗程 0.59 美元，并且在卫生所之间差异很大，从每疗程 0.38 美元到 2.74 美元不等。发现卫生所之间存在大量规模经济，最小的卫生所每实施一个月的课程的平均成本最高。为 10 岁以下儿童提供 SMC 可能是负担得起的，特别是在避免大量治疗费用的情况下。在其他情况下，对 SMC 进行成本效益的估计必须考虑到在不同的交付月份和卫生所之间的平均成本变化。
