The economic cost of malaria in Brazil

Although models exist to estimate the economic costs of malaria, more detailed studies that break down the cost considering the different agents involved (health providers, individuals, the community), regional inequalities, productivity losses, and other non-tangible costs are scarce. In general, economic costs can be classified into two categories, direct (treatment and control) and indirect (value of time lost due to morbidity or premature mortality) and fall on the health system, families and society. Although estimates are available for some countries or regions, methodological diversity is an impediment to international comparison. The economic cost of malaria in Brazil is unknown. There is no estimate of the total cost, nor of costs for smaller geographical units (which allow to capture spatial heterogeneities in transmission and their consequences on expenses). Another important gap is the lack of cost estimates that allow a breakdown by type of activity, (control, surveillance, outbreak management and prevention of reintroduction) and how these costs are financed by the agents involved (health system, families or society). These gaps prevent strategic planning for local malaria control, and optimal allocation of resources based on a cost-effectiveness analysis. This proposal aims to fill that gap. This study will use the past five years to obtain estimates for different scenarios of disease transmission, decline (before 2017) and increase (after 2017). Regional breakdown is essential given the presence of distinct epidemiological patterns of malaria transmission in Brazil: on the one hand, the Amazon region (9 states) concentrates more than 99% of cases in the country; on the other hand, the extra-Amazon region (the remaining 17 states and the federal district) has about 600 cases, more than 60% imported. Differentiation according to the type of parasite is necessary since P. vivax has extra costs related to relapses and hemolysis in patients with G6PD deficiency after treatment with primaquine. In addition, the elimination plan in Brazil focuses on P. falciparum (14). In summary, this study not only fills a knowledge gap, but provides a detailed estimate of the economic cost of malaria, which will generate inputs for the formulation of effective malaria control policies at the national and local levels. The general objective of this proposal is to provide a more comprehensive estimate of the economic cost of malaria in Brazil, filling the gap in current scientific knowledge. 1) Develop a detailed model for estimating the economic cost of malaria considering different types of costs and agents involved. Hypothesis: In order to properly assess the costs of malaria, it is essential to consider direct and indirect costs (from the perspective of the health professional and the individual / community) and differences by type of parasite (for example, P. vivax relapses), spatial pattern of the disease. transmission, and idiosyncrasies in treatment regimens (eg, G6PD deficiency). 2) Estimate the economic cost of malaria, broken down by Federation Unit, year, type of parasite and financing agent (health service provider, individual / family and community). To this end, sources of publicly available administrative information, household surveys conducted in selected municipalities in the Amazon, and qualitative interviews with local managers and decision makers involved in malaria services will be used. Hypothesis: Malaria costs are regionally heterogeneous, due to inequalities in incidence, type of parasite, socioeconomic conditions, and efforts to prevent the reintroduction of the disease. Considering these differences is crucial for the proper implementation of control strategies, and should be considered in the cost estimates. Administrative data are insufficient to capture the direct and indirect costs and it is therefore necessary to conduct specific research with standardized instruments to assess the cost and burden of the disease. 3. Develop an application to be used by the PNCM and local coordinators, allowing the calculation of the economic costs of malaria. Hypothesis: There is a lack of local capacity and training that limit the use of data collected routinely, weakening policy planning and implementation. By having an accessible tool to calculate the economic costs of malaria, decision-makers will be able to formulate appropriate policies to deal with the malaria burden. Impact. Despite the significant burden of malaria, the economic costs of the disease in Brazil remain unknown, making it difficult to make appropriate decisions to control the disease in different locations. The activities proposed by this study will address these gaps. It is essential that data be transformed into knowledge and concrete evidence that can guide the design of malaria control policies. Without this knowledge, the pace and success of efforts to eliminate malaria in Brazil will be much slower and potentially compromised.

Financing & Economics
Modeling

Feb 2020 — Jan 2023

Brazil