Efficiency and economic analysis of intervention strategies for recurrent malaria transmission

In epidemiological modelling, efficiency and economic analyses have become important metrics for identifying efficient and cost-effective intervention strategies that avert highest number of infection cases at cheapest implementation cost. This study examines an optimal control model for malaria dynamics which incorporates all the three categories of recurrent malaria such as, relapse, re-infection and recrudescence with four interventions including, personal protection using insecticide-treated bed nets, anti-relapse strategy using anti-hypnozoites drug, treatment control using anti-malaria drug, and vector control using insecticide spraying. Detailed efficiency and economic methodologies are employed to analyse the model by considering different combinations of interventions which are classified into four distinct groups, namely single control, double control, triple control, and quadruple control interventions. In each of the groups, most efficient intervention is obtained by calculating efficiency indices of each intervention, while most cost-effective intervention is determined using average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER) methods. Furthermore, overall groups, it is shown that quadruple control which combines all the four interventions is the most efficient, while personal protection using insecticide-treated bed nets from the single control group is found to be the most cost-effective intervention. Hence, intervention strategies capable of bringing down the menace of recurrent malaria in the population are provided based on availability of resources.