Protocol for an economic evaluation of perennial malaria chemoprevention delivered at scale in Benin, Cameroon, and Côte d’Ivoire

Malaria continues to impose a significant mortality and morbidity burden, particularly among young African children. Children under two years of age account for one-third of the estimated 597,000 annual global malaria deaths. Perennial malaria chemoprevention (PMC) is a strategy recommended by the World Health Organization to reduce malaria in this high-risk age group. However, uptake remains low in many endemic countries. Given the limited resources available for health and the stagnation of malaria budgets over the last decade, it is important for policymakers to understand the costs and cost-effectiveness of PMC to support future decision making.

Methods
We describe the design of an economic evaluation of PMC in Benin, Cameroon, and Côte d’Ivoire, where it is being implemented at scale by the ministries of health through the Essential Programme of Immunization (EPI) with support from Population Services International. We will take a disaggregated societal perspective, collecting data on resources provided for PMC by 45 health facilities across 12 districts in these three countries, higher levels of the health services, donor-supported activities, and households. This study will assess the financial and economic costs per dose of PMC and calculate the incremental cost per malaria case averted and per disability-adjusted life-year averted by PMC compared to the usual standard of care. We will model the costs and effects of scaling up PMC to other regions in the three countries where PMC is deemed suitable.

Discussion
This economic evaluation aims to provide robust evidence from three countries, each implementing different PMC delivery models, regarding whether, where, and under what circumstances investing in PMC may represent an efficient and equitable use of scarce resources. We expect these findings to be valuable for the governments of Benin, Cameroon, and Côte d’Ivoire and other countries and international donors in designing the optimal mix of malaria control interventions.