Economic studies of malaria in pregnancy interventions

A pregnant woman from the Zankalli community, GhanaProject Coordinator:  Kara Hanson (UK)

Economics Working Group members: Elisa Sicuri (Spain), Jayne Webster and Silke Lutzelschwab (UK)

Although there is an increasing body of evidence about the cost-effectiveness of malaria treatment and prevention interventions in the general population and for specific target groups, little is known about the cost-effectiveness of these interventions in pregnant women.  Evidence is particularly limited outside of the high transmission settings of sub-Saharan Africa, for non-falciparum malaria and for cost-effectiveness of interventions delivered in packages (for example, intermittent preventive treatment + insecticide-treated nets).  Current cost-effectiveness studies also suffer from the very limited evidence on the economic burden of malaria in pregnancy and how this burden is reduced by interventions.  This is especially true of the short term economic consequences of low birth weight (one of the main consequences of malaria during pregnancy), and the longer term health and economic effects on child development.  

A range of economic studies will be conducted alongside the MIP trials in Asia, Latin America and Africa.  Firstly, the economic burden of malaria in pregnancy will be estimated from different economic perspectives using a variety of methods.  Cross-sectional household and facility surveys will estimate the economic cost of preventing and treating malaria in pregnancy. In a number of settings babies will be followed up for 12 months after delivery and information on health service utilisation will be recorded. This information will be used to estimate the excess health care cost associated with low birth weight. Modelling approaches will be used to examine the potential long term effects of low birth weight including reduced educational attainment and economic productivity.    Secondly, cost-and cost-effectiveness analyses will be conducted alongside both prevention and case management trials.  And thirdly, information to support decision making will be provided by modelling the costs and affordability to national governments of implementing MIP interventions, and exploring the costs of alternative approaches to their targeting and delivery.