COST-EFFECTIVENESS ANALYSIS OF PIPERONYL BUTOXIDE (PBO) LONG LASTING INSECTICIDE NETS (LLINS) COMPARED TO NON PBO LLINS IN THE REDUCTION OF MALARIA AMONG CHILDREN LESS THAN TEN YEARS IN JINJA DISTRICT

Abstract

Background: Vector resistance in Uganda has threatened to reverse the present gains in Malaria control. To address the challenge of vector resistance, WHO recommends the distribution of Piperonyl Butoxide (PBO) Long Lasting Insecticide Treated Nets (LLINs) which are more effective; however, the cost effectiveness of their use is still unknown. Cost effectiveness studies are crucial to help inform governments in resource poor setting on how best to prioritize between the new PBO-LLINs and the Non PBO-LLINs. This study therefore aimed to determine the cost effectiveness of PBO-LLINs and the conventional Non PBO-LLINs in the reduction of Malaria among children in Jinja District. Methodology: A Markov model was used to simulate the sequence of malaria morbidity in a hypothetical Ugandan cohort of children aged 2 years using an 8 year time horizon and two-weeks cycle length. Model parameters were obtained using data from the experts from Ministry of Health (MOH), Malaria Consortium and published literature. The provider’s perspective was used to explore the costs and health outcomes, which were measured as Quality Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses conducted. ICERs less than three times the GDP per capita ($604.4*3) and less than once the GDP per capita ($604.04) were classified as cost-effectiveness and very cost-effective respectively following WHO guidelines. Results: The unit cost of PBO-LLIN program was US$ 116 and US$ 71 for Non-PBO LLIN program (incremental unit cost=US$ 45). The unit QALYs gained under the PBO arm were US 26.9 QALYs and 25.6 QALYs under the Non-PBO (incremental QALYs = 1.3). In the base case analysis, the ICER comparing PBO-LLIN to the non-PBO LLIN was $ 34.22 per QALY gained. This indicated that the PBO-LLIN were very cost effective as it was less than the Ugandan GDP per capita (US$ 604.04). The PBO-LLINs remained cost effective irrespective of variations in most of the model parameters. However PBO-LLINs were not cost effective when their efficacy was lower than 0.808. Conclusions: This study showed that PBO-LLINs were very cost effective compared to non-PBO-LLINs. However, cost-effectiveness could be lost if the effectiveness of PBO-LLINs reduced. Efforts to further optimize the effectiveness of PBO-LLINs through proper usage would increase the cost-effectiveness of PBO-LLINs. However, this study needs to be replicated in areas with different malaria endemicity.