Insecticide treated wall liner: Cost-effectiveness of a new tool for malaria prevention

While insecticide treated nets (ITNs) and other strategies have reduced the burden of malaria, the disease remains a major cause of morbidity and mortality across sub-Saharan Africa. We assessed the cost-effectiveness of a promising new malaria prevention tool, the insecticide treated wall liner (ITWL). Its manufacturer projects a useful life of 3-4 years. The efficacy of ITWL is based on a 6-month cluster randomized trial by Gimnig et al of 1,592 children (aged 6 months-11 years) in 12 rural villages in Nyanza Province, Kenya during 2010. Control villages had only ITNs; experimental villages had both ITNs and ITWLs. The cost-effectiveness analysis considered unit costs and quantities of each input, demographic records, and published literature. The adjusted protective efficacy for ITWL was 38% (95% CI: 23%-50%), or 1.1 infection averted per child per year. The added cost of ITWL was US$64.23 per person covered, consisting of ITWL's projected factory price (44.9%), shipping and offloading (5.1%), management and supervisory personnel (24.5%), installation materials (0.4%), local transportation (13.9%), and installation labor (11.1%). Under the least favorable assumption (ITWL protection ends at 3 months, the average follow up in the previous trial), the cost per discounted life-year gained (DLYG) is US$4,837. Under the most favorable assumption (ITWL remains effective for 4 years), the cost per DLYG is US$482. Kenya's per capita GDP in 2010 was US$795. WHO considers interventions with cost-effectiveness ratios below a country's GDP highly cost-effective. As long as ITWL remains effective for at least 2.2 years, it will be highly cost-effective.