Ruisch Anika, Iodice Miranda, Mathur Ishani, Harris Sara, Walker Damian G, Owusu Richmond, Nonvignon Justice, Gilmartin Colin
Management Sciences for Health, Arlington, VA, USA.
School of Public Health, University of Ghana, Accra, Ghana.
Malar J. 2024 Dec 18;23(1):384. doi: 10.1186/s12936-024-05217-1.
Implemented in 17 countries to date, seasonal malaria chemoprevention (SMC) is a recommended strategy to prevent childhood malaria in areas with seasonal transmission of P. falciparum through monthly administration of antimalarial medicines. Understanding the costs and resource requirements of SMC delivery is necessary for effective planning and resource allocation. This systematic literature review aims to assess the evidence on the cost and cost-effectiveness of SMC delivery.
Following PRISMA guidelines, five databases were systematically reviewed to identify evidence on SMC costs and cost-effectiveness published between 2012 and 2023. Studies with defined costing methodologies and cost output measures were included, excluding those relying solely on mathematical modeling. Two reviewers assessed each study for eligibility and extracted cost data, which were adjusted for inflation. Quality assessment was completed using the CHEERS checklist.
Six costing studies were identified spanning nine countries. Four studies examined costs during an SMC pilot or introduction, one during scale-up, and one costed newly established SMC campaigns through a multi-country project. Costs were examined at country level with the financial costs per child receiving a full course of SMC ranging from $1.71 to $12.46, while economic costs per child ranged from $2.11 to $29.06. Four studies included a cost effectiveness analysis with incremental cost-effectiveness ratios (ICERs) per clinical malaria case averted ranging from $5.41 to $138.03; ICER per disability-adjusted life year (DALY) averted from $24.51 to $182.88; and ICER per death averted from $688.86 to $18,418.81. Differences in cost estimates stemmed from different factors including variations in cost ingredients, scale of the intervention, and study perspectives.
The level of detail for reporting SMC costs and cost categories varied greatly by study as did the scale of intervention, limiting comparability as well as an understanding of the complete costs and resource requirements for SMC implementation. Cost evidence is not from mature programs but from pilots or relatively new campaigns. Costs incurred by households and costs of the integrated delivery of SMC with other health interventions were often overlooked. Adopting a standardized costing approach for mature SMC programmes could provide a better understanding of resource requirements and costs while enhancing study comparability across settings, better informing future resource allocation and improving efficiency.
季节性疟疾化学预防（SMC）是一项推荐策略，旨在通过每月服用抗疟药物，预防恶性疟原虫季节性传播地区的儿童疟疾。截至目前，该策略已在17个国家实施。了解实施SMC的成本和资源需求对于有效规划和资源分配至关重要。本系统文献综述旨在评估有关SMC实施成本和成本效益的证据。
遵循PRISMA指南，系统检索了五个数据库，以确定2012年至2023年间发表的关于SMC成本和成本效益的证据。纳入了具有明确成本核算方法和成本产出指标的研究，排除了仅依赖数学模型的研究。两名评审员评估每项研究的合格性并提取成本数据，这些数据进行了通货膨胀调整。使用CHEERS清单完成质量评估。
确定了六项成本核算研究，涉及九个国家。四项研究考察了SMC试点或引入阶段的成本，一项考察了扩大规模阶段的成本，一项通过多国项目对新建立的SMC项目进行了成本核算。在国家层面考察了成本，接受完整疗程SMC的每个儿童的财务成本从1.71美元到12.46美元不等，而每个儿童的经济成本从2.11美元到29.06美元不等。四项研究包括成本效益分析，每避免一例临床疟疾病例的增量成本效益比（ICER）从5.41美元到138.03美元不等；每避免一个伤残调整生命年（DALY）的ICER从24.51美元到182.88美元不等；每避免一例死亡的ICER从688.86美元到18418.81美元不等。成本估计的差异源于不同因素，包括成本构成要素的差异、干预规模和研究视角。
不同研究报告SMC成本和成本类别的详细程度差异很大，干预规模也是如此，这限制了可比性以及对SMC实施的完整成本和资源需求的理解。成本证据并非来自成熟项目，而是来自试点或相对较新的项目。家庭承担的成本以及SMC与其他卫生干预措施综合实施的成本往往被忽视。为成熟的SMC项目采用标准化成本核算方法，可以更好地理解资源需求和成本，同时提高不同环境下研究的可比性，为未来资源分配提供更充分的信息并提高效率。
