Paudel Uttam, Pant Krishna Prasad
Tribhuvan University, Kathmandu, Nepal.
Kathmandu University, Kathmandu Nepal.
Heliyon. 2020 May 3;6(5):e03886. doi: 10.1016/j.heliyon.2020.e03886. eCollection 2020 May.
Governments have committed to eliminate malaria. But a decline in government investment in malaria interventions, particularly in developing countries such as Nepal, reveals a limited emphasis on malaria elimination that may be due to lack of strong evidence on benefits of the investment. This paper empirically analyses curative and preventive costs and benefits of Nepal's malaria elimination program from the perspectives of both service providers in the public sector and people who are at risk.
Cost benefit analysis of both curative and preventive interventions for malaria elimination was conducted using case and non-case household survey data. Secondary data were obtained from government sources. Ingredient approach and step-down methods were used to estimate costs of malaria elimination interventions, and willingness to pay (WTP) method and case averted approach to estimate benefits.
Curative intervention of malaria elimination program is economically viable in Nepal with a net present value (NPV) of USD 23 million, benefit cost ratio (BCR) of 1.58 and internal rate of return of 63%. Malaria preventive intervention is highly beneficial with NPV of USD 435 million and BCR of 2.13. An annual investment of USD 36.59 million is required to continue the current pattern of malaria reduction that can generate societal benefits of USD 92.81 million. From this investment, the government can save USD 132 million by the end of 2025. The maximum WTP of case households for the intervention is USD 57 per household which is 63% higher than that of non-case households.
Malaria elimination program in Nepal is economically viable and investment worthy. As the preventive intervention generates much higher net benefits than the curative intervention, the government should emphasize on preventive intervention while continuing the curative interventions.
各国政府已承诺消除疟疾。但政府对疟疾干预措施的投资有所下降，尤其是在尼泊尔等发展中国家，这表明对消除疟疾的重视程度有限，这可能是由于缺乏关于投资效益的有力证据。本文从公共部门的服务提供者和高危人群的角度，对尼泊尔疟疾消除计划的治疗和预防成本及效益进行了实证分析。
利用病例和非病例家庭调查数据，对消除疟疾的治疗和预防干预措施进行成本效益分析。二级数据来自政府来源。采用成分法和逐步递减法估算疟疾消除干预措施的成本，采用支付意愿法和避免病例法估算效益。
尼泊尔消除疟疾计划的治疗干预措施在经济上是可行的，净现值为2300万美元，效益成本比为1.58，内部收益率为63%。疟疾预防干预措施非常有益，净现值为4.35亿美元，效益成本比为2.13。需要每年投资3659万美元来维持目前减少疟疾的模式，这可以产生9281万美元的社会效益。通过这项投资，政府到2025年底可以节省1.32亿美元。病例家庭对该干预措施的最大支付意愿为每户57美元，比非病例家庭高63%。
尼泊尔的疟疾消除计划在经济上是可行的，值得投资。由于预防干预措施产生的净效益远高于治疗干预措施，政府在继续进行治疗干预措施的同时，应强调预防干预措施。
