Analysis of the cost-effectiveness of the implementation of Indoor Residual Spraying and distribution of Long-Lasting Insecticidal Nets in the municipality of Kouande and municipality of Copargo in Benin

Background: In Benin, malaria was the leading cause of hospital consultation for children less than 5 years old (47.2%), and for all patients not hospitalized (42.3%). Its incidence among those who attended a health facility was respectively 42.9% and 17%. To address this problem, the National Program for the Fight against Malaria undertook, in 2011, a mass campaign of distribution of Long-Lasting Insecticidal Nets (LLINs). In addition to this strategy, the program decided to implement Indoor Residual Spraying in 7 of the 9 municipalities of Atacora department, which is one of the most malaria endemic areas. The objective of this study was to see if adding the IRS to the LLINs (municipality of Kouande) strategy is cost-effective, as compared to the LLINs-only strategy (municipality of Copargo), in highly malaria endemic areas. Method: This study was a cross-sectional study of the implementation of the IRS from June 2011 to July 2011. Regarding the selection of health workers, managers of the malaria program, and partners of implementation of the IRS, a reasoned choice was made. The data collection consisted mainly of a series of interviews with people responsible for resource management and the exploitation of documents provided by them. Results: After the implementation of LLNs + IRS the annual incidence of malaria in health facilities decreased significantly at Kouande-Centre and at Guilmaro. In the same period it increased significantly at Copargo-Centre, and decreased at Pabegou. The average cost per malaria case prevented (CE) was respectively 85,572.4 FCFA at Copargo Centre, 38,932.6 FCFA at Kouande Centre, 15,940.6 FCFA at Pabegou and 174,728.5 FCFA at Guilmaro. According to the results, the CE ratio at Kouande-Centre is lower than the CE ratio at Copargo-Centre and the CE ratio at Guilmaro is higher than the CE ratio at Pabegou. The LLINs + IRS strategy is more cost effective in urban areas than the LLINs-only strategy. The opposite result is observed in rural areas. Conclusion: The LLINs + IRS strategy is cost effective in highly endemic areas both urban and rural, if communities sleep in sprayed structures and use LLINs even when it is hot.