Skip to main content
. 2012 Jul 6;90(9):672–684E. doi: 10.2471/BLT.11.094771

Table 3. Characteristics associated with financial and economic costs of insecticide-treated nets (ITNs) in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria, by delivery strategya.

Delivery strategy Country, scale Perspective, interval Cost
Net lifespanc Sensitivity analysis Outcomed
Financial Economic Distributionb
Continuous
Full subsidy (free); routine health services (ANC clinic) and/or community-based
ANC clinics to PW (free); implemented in 2006 Burkina Faso, 1 district (Kossi)22 Societal, 2006–2007 ANC clinic: provider costs for MoH, including training, supervision, LLIN transport Capital costs annualized (LLINs over 5 y, vehicles over 7 y) and discounted (3%); all prices at 2006 levels were converted to US dollars; detailed opportunity costs were calculated for space and personnel on project ANC clinic: ITNs, 23%; transport, 15%; staff, 54% LLIN, 5 years (physical and treatment) Discount rate; LLIN lifespan; costs of transport, personnel, rent and IEC materials; leakage of LLINs Financial cost per LLIN delivered, US$ 8.20; economic cost per LLIN delivered, US$ 5.47 (range: 5.38–6.83); all outcomes were most sensitive to LLIN lifespan and leakage
From 2001, ANC clinics to PW (free) and in HF and CHW to GP (full cost; free after 2003) Eritrea, national (Stevens)25 Provider, 2001–2005 All direct costs to provider, including commodities, delivery, IEC activities, staff, taxes Capital costs were annualized and discounted (3%); all prices at 2005 levels converted to US dollars; Shared costs for personnel and space on project calculated ITNs and insecticide, 64%; staff, 21% ITN, 3-year physical lifespan; new ITN or retreatment provide 1 TNY Discount rate; ITN cost, use, lifespan and effectiveness; proportion of shared costs Outcomes most sensitive to ITN costs and shared cost allocation: financial cost per ITN delivered, US$ 10.67; financial cost per TNY, US$ 3.23; economic cost per ITN delivered, US$ 9.00 (range: 7.44–23.29); economic cost per TNY, US$ 2.74
Outcomes most sensitive to ITN effectiveness and use: cost per child death averted, US$ 3276 (range: 1637–13 104); cost per DALY averted, US$ 100 (range: 81–398)
ANC clinics to PW (free) in 2001 Kenya, 35 districts26 Provider, 2001 ITNs and transport (international, to district, to ANC facilities) Not reported Not reported Not reported Not reported Financial cost per ITN delivered to ANC clinics, US$ 7.64; financial cost per ITN delivered to PW, US$ 10.54
ANC clinics to PW (free) in 2007 Uganda, 2 districts (Adjumani, Jinja)27 Provider, 2007 Detailed costs of LLINs, transport, storage, distribution, IEC activities, training, personnel Capital costs annualized (ITNs over 3 y, vehicles over 7.5 y); shared costs of personnel time and overhead; all costs were incurred in 2007, so no inflation adjustment was made; prices converted to US dollars LLIN transport, 33%; IEC, 23%; training, 23%; and management, 12%e LLIN, 3 years (physical and treated) Discount rate; LLIN lifespan and cost; net use and retention Financial cost per LLIN delivered, US$ 8.83; economic cost per LLIN delivered, US$ 5.89 (range: 4.93–7.08); economic cost per TNY, US$ 1.96; all outcomes were most sensitive to LLIN lifespan
Partial subsidy; routine health services (HFs; ANC and/or MCH clinics) and/or retailers and/or community-based
Retail to GP (partial subsidy); implemented in 2006 Burkina Faso, 1 district (Kossi)22 Societal, 2006–2007 Retailer: provider costs incurred by NGO, wholesalers and shopkeepers, including transport, storage, labour, profit, IEC materials Capital costs annualized (LLINs over 5 y, vehicles over 7 y) and discounted (3%); all prices at 2005 levels were converted to US dollars; detailed opportunity costs for space and personnel; user contribution calculated difference between provider’s financial costs and actual costs recovered Retail: ITNs, 23%; wholesaler/retailers, 25%; staff 22% LLIN, 5 years (physical and treatment) Discount rate; LLIN lifespan; costs of transport, personnel, rent and IEC materials; leakage of LLINs Financial cost per LLIN delivered, US$ 9.19; economic cost per LLIN delivered, US$ 5.47 (range: 5.38–6.83); all outcomes were most sensitive to LLIN lifespan and leakage
From 2002, MCH clinics to PW and children < 5; after 2003, to GP by community-based groups (partial subsidy) Malawi, national3 Provider, 1999–2003 Capital and recurrent costs, including ITNs, vehicles, staff, brand creation, advertising, promotion Capital costs annualized (ITNs over 5 y, brand over 7 y, vehicles over 8 y) and discounted (3%); all prices at 1999 levels converted to US dollars ITNs, 55%; staff, 10%; supplies/ overhead, 10%; fuel, 9% ITN, 5-year physical lifespan; treatment provides 0.5 TNY Not reported Average economic cost per ITN delivered, US$ 11.16 (decreased from US$ 21.39 in 1999 to US$ 8.15 in 2003 as number of ITNs distributed increased, suggesting economies of scale); average economic cost per TNY, US$ 18.72 (decreased from US$ 32.64 in 1999 to US$ 14.60 in 2003)
From 1997; HF, community-based delivery and retailers to GP (partial subsidy) United Republic of Tanzania, 2 districts (Kilombero, Ulanga)36 Provider, user, 1996–2000 Capital and recurrent costs divided into set-up (branding, sensitization) and ongoing supply (ITNs, personnel, transport, training, promotion) Capital costs annualized (ITNs over 5 y, brand over 7 y, vehicles over 10 y) and discounted (3%); opportunity costs providers and users (including price for ITN); all prices at 2000 levels converted to US dollars ITNs and insecticide, 31%; staff, 28%; other recurrent costs, 32% ITN, 5-year physical lifespan; treatment provides 0.5 TNY Health measures (ITN coverage, inclusion of untreated nets, duration of effectiveness) Economic cost per TNY, US$ 25.09 and US$ 12.57 if insecticide lasts 6 and 12 months, respectively; economic cost per child death averted, US$ 2924 (range: 1101–1909); economic cost per DALY averted, US$ 107 (range: 41–69); all outcomes were sensitive to all measured assumptions
From 2004, ANC clinics to PW (partial subsidy via voucher at retailer)
United Republic of Tanzania, national35
Provider, user, 2004–2006
Capital and recurrent costs, including formative research, planning, training, vehicles, ITNs, IEC, personnel, overhead
Capital costs annualized (ITNs over 3 y, vehicles over 8 y) and discounted (3%); opportunity costs for providers and users (including top up paid for ITN); all prices at 2006 levels converted to US levels
ITN: 20% subsidised, 8% to user 8%; staff, 25%; promotion activities, 16%
ITN, 3-year physical lifespan;
new ITN or retreatment
provide 1 TNY
Discount rate; user top up; ITN price, effective lifespan and re-treatment use; LLINs
Financial cost per ITN delivered, US$ 12.09; economic cost per ITN delivered, US$ 10.77 (range: 10.53–12.23); economic cost per TNY, US$ 6.02 (range: 5.88–12.03]; economic cost per child death averted, US$ 1 242 (range: 1 219–2496); all outcomes were most sensitive to ITN lifespan and use
Time-limited
Full subsidy (free); stand-alone campaign
Stand-alone net campaign to children < 5 (free) in 2007 Uganda, 2 districts (Adjumani, Jinja)27 Provider, 2007 Detailed costs of LLINs, transport, storage, distribution, IEC activities, training, personnel Capital costs annualized (ITNs over 3 y, vehicles over 7.5 y); Shared costs of personnel time and overheads; all costs were incurred in 2007, so no inflation adjustment was made; prices converted to US dollars Distribution, 30%; LLIN transport, 15%; registration, 16%; IEC, 13%e LLIN, 3 years (physical and treated) Discount rate, LLIN lifespan and cost; net use and retention Financial cost per LLIN delivered, US$ 8.30 (Jinja) and US$ 9.49 (Adjumani); economic cost per LLIN delivered, US$ 3.86 (Jinja) and US$ 4.76 (Adjumani) (range: 2.91–6.06); economic cost per TNY, US$ 1.29 (Jinja) and US$ 1.58 (Adjumani); all outcomes were most sensitive to LLIN lifespan
Full subsidy (free); integrated with public health campaign
Distribution integrated with measles vaccination campaign to children < 5 (free) in 2002 Ghana, 1 district (Lawra)30 Provider, 2002 ITNs, transportation, training, supervision, social mobilization; campaign costs that would have been incurred for measles vaccination without inclusion of ITNs were excluded Not reported Financial costs only; ITNs, 91%; other elements of delivery, 9% Not reported Not reported Financial cost per ITN delivered, US$ 11.53
Distribution integrated with measles vaccination campaign to children < 5 (free) in 2005 United Republic of Tanzania, 1 region (Lindi)45 Provider, 2005 ITNs, transport to district, IEC activities, NMCP staff Not included Financial costs only: ITNs 88%; other elements of delivery, 12% Not reported Not reported Financial cost per ITN delivered, US$ 3.71
Distribution integrated with measles vaccination campaign to children < 5 Zambia, 5 districts (Chilubi, Kaputa, Mambwe, Nyimba, Kalalushi49 Provider, 2003 ITNs, transport, training, IEC activities; campaign costs that would have been incurred for measles vaccination without inclusion of ITNs were excluded Not reported Financial costs only: ITNs, 94%; other elements of delivery, 6% Not reported Not reported Financial cost per ITN delivered, US$ 10.88 in rural areas and US$ 11.79 in urban areas

ANC, antenatal care; CHW, community health worker; DALY, disability-adjusted life year; GP, general population; HF, health facility; IEC, information education communication; LLIN, long-lasting insecticide-treated net; MCH, maternal and child health; MoH, ministry of health; NGO, nongovernmental organization; NMCP, national malaria control programme; PW, pregnant women; TNY, treated-net-year (incorporates ITNs and retreatment kits distributed); US$, United States dollars.

a Studies may appear in more than one category if multiple strategies were used to deliver ITNs at scale or if strategies changed over time.

b Reported as the percentage of total economic costs (unless specified otherwise). Only main costs are reported.

c Defined as physical viability and duration of insecticide protection.

d Adjusted for inflation and reported in 2010 US dollars to allow comparison across different countries and years.

e Reported as the percentage of total costs, excluding LLIN cost.