Table 1.
Summary of model parameters for Extended Cost-Effectiveness Analysis (ECEA)
| Parameter | Value for each wealth quintile (Q1–Q5) if applicable | References and notes | |
|---|---|---|---|
| Demographics | Number of under-five children in Nigeria |
Q1 = 8,822,526 Q2 = 7,737,789 Q3 = 6,436,105 Q4 = 5,806,958 Q5 = 5,185,042 |
Authors’ calculation using national population size, median household size, and number of under-fives per households from [16] |
| Epidemiology | Treatment sought for under-5 malaria (%) |
Q1 = 67.8 Q2 = 70.4 Q3 = 72.4 Q4 = 79.1 Q5 = 85.2 |
[16] |
| Annual cases of under-five malaria in Nigeria |
Q1 = 6,960,185 Q2 = 6,468,963 Q3 = 5,261,275 Q4 = 3,361,056 Q5 = 1,318,521 |
Authors’ calculation using prevalence data from [16] | |
| Cumulative annual incidence of uncomplicated under-five malaria (%) |
Q1 = 77.1 Q2 = 81.9 Q3 = 80.2 Q4 = 57.0 Q5 = 25.2 |
Authors’ calculation using treatment-seeking behaviour and probability of disease progression to severe from [16] and [53] | |
| Cumulative annual incidence of severe under-five malaria (%) |
Q1 = 1.8 Q2 = 1.7 Q3 = 1.6 Q4 = 0.8 Q5 = 0.3 |
Authors’ calculation using treatment-seeking behaviour and probability of disease progression to severe from [16] and [53] | |
| Treatment coverage increase for 50% DMC subsidy (percentage point) |
Q1 = 2.5 Q2 = 2 Q3 = 1.5 Q4 = 1 Q5 = 0.5 |
Authors’ assumption | |
| Treatment coverage increase for full DMC subsidy (percentage point) |
Q1 = 5 Q2 = 4 Q3 = 3 Q4 = 2 Q5 = 1 |
Authors’ assumption | |
| Treatment coverage increase for full DMC + NMC + IC subsidy (percentage point) |
Q1 = 10 Q2 = 8 Q3 = 6 Q4 = 4 Q5 = 2 |
Authors’ assumption | |
| ACT prescribed in those seeking treatment (%) |
Q1 = 46.6 Q2 = 51.5 Q3 = 52.5 Q4 = 53.1 Q5 = 61 |
[16] | |
| Treatment | ACT efficacy (%) | 98.3 | [14] |
| Adherence to treatment for uncomplicated cases (%) |
Q1 = 66 Q2 = 71 Q3 = 76 Q4 = 81 Q5 = 86 |
Authors’ assumption using overall estimate of adherence across all wealth indices from [40] | |
| Efficacy of ACT for uncomplicated cases given non-adherence as a proportion of theoretical efficacy (%) | 94.7 | [54] | |
| Non-ACT efficacy (%) | 63 | Authors’ calculation using efficacy of chloroquine and all other non-ACTs from [6] | |
| Probability that untreated case progresses to severe (%) | 7 | Calibrated with low estimates from [53] | |
| Probability that treatment failure progresses to severe (%) | 2 | [55] | |
| CFR of untreated severe malaria (%) | 45 | Calibrated with low estimates from [52] | |
| CFR of treated severe malaria (%) | 4.9 | [56] | |
| CFR of untreated uncomplicated malaria (%) | 0.1 | Authors’ assumption based on [57] | |
| Costing (2020 $US) | Outpatient OOP direct medical costs per case, ACTs used | 7.98 | Authors’ calculation using forthcoming data from multi-facility Duke costing study (see Additional file 1 Section I, Table S8) |
| Outpatient OOP direct medical costs per case, non-ACTs used | 6.29 | Authors’ calculation using [6]. and forthcoming data from multi-facility Duke costing study (see Additional file 1 Section I, Tables S8 and S9) | |
| Outpatient OOP direct non-medical costs per case | 2.26 | Authors’ calculation using forthcoming data from multi-facility Duke costing study (see Additional file 1 Section I, Table S10) | |
| Outpatient OOP indirect costs per case |
Q1 = 0.49 Q2 = 0.78 Q3 = 1.14 Q4 = 1.70 Q5 = 3.16 |
Authors’ calculation using data on daily consumption and days spent caregiving from [58] | |
| Inpatient OOP direct medical costs per case | 39.25 | Authors’ calculation using forthcoming data from multi-facility Duke costing study (see Additional file 1 Section I, Table S8) | |
| Inpatient OOP direct non-medical costs per case | 4.16 | Authors’ calculation using forthcoming data from multi-facility Duke costing study (see Additional file 1 Section I, Table S10) | |
| Inpatient OOP indirect costs per case |
Q1 = 2.98 Q2 = 4.75 Q3 = 6.91 Q4 = 10.36 Q5 = 19.26 |
Authors’ calculation using data on daily consumption and days spent caregiving from [58, 59] | |
| OOP indirect cost of non-treatment per untreated case (uncomplicated) |
Q1 = 2.45 Q2 = 3.9 Q3 = 5.67 Q4 = 8.49 Q5 = 15.79 |
Authors’ calculation using data on daily consumption and days spent caregiving from [58, 59] | |
| OOP indirect cost of non-treatment per case (severe) |
Q1 = 4.89 Q2 = 7.79 Q3 = 11.34 Q4 = 16.99 Q5 = 31.58 |
Authors’ calculation using data on daily consumption and days spent caregiving from [58, 59] | |
| Outpatient cost of implementation per case, ACTs used | 10.50 | Authors’ calculation using estimates of OOP expenditure as a percentage of total health expenditure in Nigeria [43] | |
| Outpatient cost of implementation per case, non-ACTs used | 8.28 | Authors’ calculation using estimates of OOP expenditure as a percentage of total health expenditure in Nigeria [43] | |
| Inpatient cost of implementation per case | 51.65 | Authors’ calculation using estimates of OOP expenditure as a percentage of total health expenditure in Nigeria [43] | |
| Nigeria GNI | 2030 | [60] | |
| Nigeria Gini Index | 35.1 | [61] |
DMC direct medical cost, NMC non-medical cost, IC indirect cost, ACT artemisinin-based combination therapy, CFR case-fatality rate, OOP out-of-pocket, GNI gross national income