Bed nets are integral to national malaria programmes.

1. Bed nets are integral to national malaria programmes. WHO recommends using long-lasting insecticide-treated bed nets (LLINs). Few comparative studies of bed net distribution, and fewer economic evaluations of LLIN distribution Cost and cost effectiveness of long-lasting insecticide-treated bed nets: A model-based analysisA-M Pulkki-Brännström1§, C Wolff2, N Brännström3 and J Skordis-Worrall11UCL Centre for International Health and Development, University College London, UK, 2Stockholm School of Economics, Sweden, 3University of Helsinki, Finland 1. Background • Need to better understand determinants of cost effectiveness of different bed net types • When and why are LLINs preferred to conventional insecticide-treated nets? • Which lifespan should be selected for LLIN? Annual replenishment rounds (keeping coverage constant, smaller number of nets distributed, every year until next main distribution round) 3 Scenarios of replenishment need: • Annual loss rate constant proportion of nets distributed initially. • Annual loss rate constant proportion of nets of nets still in use • Loss rate increases until 50% of initially distributed nets remain • Large-scale programme with high coverage & use • ITNs distributed through existing health services. • ITNs regularly retreated at low cost • Parameters from literature review where possible • Sensitivity analysis • LLINs more cost effective than ITNs with same lifespan - unless US$ 1.5 more expensive. • For each year of a longer lifespan a bed net can be US$ 1 more expensive, while still being more cost effective. • Replenishing nets raises protective effectiveness by 5-14% . • Replenishment costs: US$ 17-25 per person per annum  US$ 1080-1610 per under-5 death averted. • Limitations: • Treatment costs, household costs of malaria: No robust estimates for different geographic areas available. • Effectiveness of untreated nets: Not enough available data • Program planners should be willing to pay a premium for nets which have a longer lifespan up to a price threshold. • Replenishment (incrementally) cost effective if planners willing to spend US$ 1610 per U5 death averted. 2. Methods Explore impact of parameters on cost effectiveness in an Excel model. Choice Variables: • Coverage (no of nets to population size), usage rate, net type, price, lifespan, delivery method,replenishment need& delivery, procurement costs, geographic area. Outcome Variables: • No. of people protected, cost per person protected, U5 deaths averted, cost per U5 death averted, DALYs averted. 10-year period considered Regular distribution rounds: • procurement and distribution costs • choice of distribution method: • Free distribution in campaign (USD 2.7) • Free distribution through routine services (USD 2.65/USD 1.4) • Subsidised sales and social marketing (USD 3.9) 3. The Model: 4. Findings 5. Conclusions