The economic value of long-lasting insecticidal nets and indoor residual spraying implementation in Mozambique

Bruce Y. Lee, Sarah M. Bartsch, Nathan T.B. Stone, Shufang Zhang, Shawn T. Brown, Chandrani Chatterjee, Jay V. DePasse, Eli Zenkov, Olivier J.T. Briët, Chandana Mendis, Kirsi Viisainen, Baltazar Candrinho, James Colborn

Research output: Contribution to journalArticle

Abstract

Malaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology.

Original languageEnglish (US)
Pages (from-to)1430-1440
Number of pages11
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume96
Issue number6
DOIs
StatePublished - 2017

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases

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    Lee, B. Y., Bartsch, S. M., Stone, N. T. B., Zhang, S., Brown, S. T., Chatterjee, C., DePasse, J. V., Zenkov, E., Briët, O. J. T., Mendis, C., Viisainen, K., Candrinho, B., & Colborn, J. (2017). The economic value of long-lasting insecticidal nets and indoor residual spraying implementation in Mozambique. American Journal of Tropical Medicine and Hygiene, 96(6), 1430-1440. https://doi.org/10.4269/ajtmh.16-0744