Cost and cost-effectiveness of indoor residual spraying with pirimiphos-methyl in a high malaria transmission district of Mozambique with high access to standard insecticide-treated nets

Table 5 Probabilistic cost-effectiveness results of the combined effect of indoor residual spraying (IRS) and insecticide-treated nets (ITNs) on a theoretical cohort of 10,000 (A) children under five years of age and (B) individuals of all ages

	Theoretical cohort of children U5			Theoretical cohort of individuals of all ages
	Point estimate	95% CI lower	95% CI upper	Point estimate	95% CI lower	95% CI upper
Incremental costs = intervention costs—malaria cost savings
Direct costs only	1,633,402.91	1,630,687.28	1,636,118.53	1,578,361.96	1,575,844.28	1,580,879.64
Direct and indirect costs	1,128,662.46	1,125,185.47	1,132,139.45	1,138,624.72	1,135,000.29	1,142,249.14
Incremental effects
Total cases averted	46,851	46,811	46,889	33,909	33,880	33,936
Uncomplicated cases averted	46,609	46,570	46,646	33,734	33,706	33,760
Severe cases averted	242	241	243	175	174	176
Deaths averted	94	93	94	30	29	30
DALYs averted	2,856.76	2,850.34	2,863.18	624.39	622.66	626.12
ICERs: incremental cost per DALY averted
ICER—direct costs only	579.46*	577.86*	581.05*	2,578.68	2,570.55	2,586.80
ICER—direct and indirect costs	400.32**	398.82**	401.82**	1,860.08	1,852.17	1,867.98

Results from the Monte Carlo simulations with 10,000 iterations using the parameter values and distributions specified in Table 1
Children U5 children under five years of age, CI confidence interval, DALY disability-adjusted life-year, ICER incremental cost-effectiveness ratio
*Implies that the combination of IRS with pirimiphos-methyl and pyrethroid itns is cost-effective compared to pyrethroid itns alone, according to the WHO-Choice threshold of three times the GDP per capita
**Implies the strategy is highly cost-effective

ISSN: 1475-2875