Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya

BACKGROUND: Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT) as delivered by teachers in schools in western Kenya. METHODS: Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly). Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. RESULTS: The delivery of IPT by teachers was estimated to cost US 1. 88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13. 2% of overall costs (equivalent to US 0. 25 per child) whilst recurrent costs accounted for 86. 8% (US 1. 63 per child per year). The estimated cost per anaemia case averted was US 29. 84 and the cost per case of Plasmodium falciparum parasitaemia averted was US 5. 36, respectively. The cost per case of anaemia averted ranged between US 24. 60 and 40. 32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US 12. 53 and 7. 52, respectively. CONCLUSION: This study provides the first evidence that IPT administered by teachers is a cost-effective school-based malaria intervention and merits investigation in other settings.