Cost-effectiveness of intermittent preventive therapy and insecticide-treated bed nets for malaria prevention among pregnant women in Jos North, Plateau State, Nigeria

Abstract

BACKGROUND: Malaria remains a major public health concern, particularly among pregnant women in endemic regions. Intermittent preventive therapy using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) is widely recommended for malaria prevention in pregnancy. However, the cost-effectiveness of these interventions, particularly in low-resource settings, needs further evaluation to inform policy and resource allocation. This study aimed to assess the cost-effectiveness of IPTp-SP and ITNs as malaria prevention strategies among pregnant women attending antenatal care (ANC) services in Jos North, Plateau State, Nigeria. METHODS: A cross-sectional study design was used to conduct a cost-effectiveness analysis (CEA) comparing IPTp-SP alone to a combined IPTp-SP/ITN intervention. A total of 1000 pregnant women accessing ANC services from 2019 to 2020 in five primary healthcare facilities were included. Cost data were collected from a provider's perspective using a cost valuation sheet adapted from the WHO CHOICE tool. Health outcomes were measured in disability-adjusted life years (DALYs) lost, with the primary outcomes being the prevalence of low birth weight (LBW) and maternal anaemia at 36-40 weeks of gestation. Data were analysed using STATA version 16, and an incremental cost-effectiveness ratio (ICER) was calculated. Probabilistic sensitivity analysis (PSA) was conducted using Monte Carlo simulations. RESULTS: The total DALYs lost were higher in the IPTp-SP-only group (101.53 DALYs) than in the IPTp-SP/ITN group (85.9 DALYs), yielding an incremental effect of 15.63 DALYs averted. The total cost of the intervention was higher for IPTp-SP/ITN (US$231.98) compared to IPTp-SP alone (US$131.79), with an incremental cost of US$100.19. The ICER was US$2.12 per DALY averted, indicating that IPTp-SP/ITN is a cost-effective intervention. The cost-effectiveness acceptability curve (CEAC) indicates that the probability of IPTp-SP/ITN being more cost-effective than IPTp-SP only at a WTP set at 150 US$/DALY is approximately 60%, suggesting that cost-effectiveness improves at higher WTP thresholds. CONCLUSION: This study demonstrates that IPTp-SP/ITN is a cost-effective intervention for preventing malaria during pregnancy. However, its cost-effectiveness is influenced by integration into ANC services, adherence to ITN use, and funding mechanisms. Policymakers should consider optimizing funding and service delivery models to improve intervention efficiency and sustainability. Further research incorporating household-level costs and long-term economic impacts is recommended.