The Macroeconomic Impact of Increasing Investments in Malaria Control in 26 High Malaria Burden Countries: An Application of the Updated EPIC Model

Document Type : Original Article

Authors

1 Department of Health System Governance and Financing, World Health Organization, Geneva, Switzerland

2 Department of International Economics, The Graduate Institute, Geneva, Switzerland

3 Strathclyde Business School, University of Strathclyde, Glasgow, UK

4 Department of Public Economics, German Institute for Economic Research (DIW Berlin), Berlin, Germany

Abstract

Background 
Malaria remains a major public health problem. While globally malaria mortality affects predominantly young children, clinical malaria affects all age groups throughout life. Malaria not only threatens health but also child education and adult productivity while burdening government budgets and economic development. Increased investments in malaria control can contribute to reduce this burden but have an opportunity cost for the economy. Quantifying the net economic value of investing in malaria can encourage political and financial commitment.

Methods 
We adapted an existing macroeconomic model to simulate the effects of reducing malaria on the gross domestic product of 26 high burden countries while accounting for the opportunity costs of increased investments in malaria. We compared two scenarios differing in their level of malaria investment and associated burden reduction: sustaining malaria control at 2015 intervention coverage levels, time at which coverage levels reached their historic peak and scaling-up coverage to reach the 2030 global burden reduction targets. We incorporated the effects that reduced malaria in children and young adolescents may have on the productivity of working adults and on the future size of the labour force augmented by educational returns, skills, and experience. We calibrated the model using estimates from linked epidemiologic and costing models on these same scenarios and from published countryspecific macroeconomic data. 

Results 
Scaling-up malaria control could produce a dividend of US$152 billion in the modelled countries, equivalent to 0.17% of total GDP projected over the study period across the 26 countries. Assuming a larger share of malaria investments is paid out from domestic savings, the dividend would be smaller but still significant, ranging between 0.10% and 0.14%
of total projected GDP. Annual GDP gains were estimated to increase over time. Lower income and higher burden countries would experience higher gains.


Conclusion 
Intensified malaria control can produce a multiplied return despite the opportunity cost of greater investments

Keywords


  1. Cibulskis RE, Alonso P, Aponte J, et al. Malaria: Global progress 2000 - 2015 and future challenges. Infect Dis Poverty. Jun 09 2016;5(1):61. doi:10.1186/s40249-016-0151-8
  2. WHO. World Malaria Report 2015. 2015.
  3. Bhatt S, Weiss DJ, Cameron E, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature. Oct 08 2015;526(7572):207-211. doi:10.1038/nature15535
  4. WHO. World Malaria Report 2020. 2020. https://www.who.int/publications/i/item/9789240015791
  5. WHO. Global Technical Strategy for malaria 2016-2030, 2021 Update. World Health Organization; 2021.
  6. Kihara M, Carter JA, Newton CR. The effect of Plasmodium falciparum on cognition: a systematic review. Trop Med Int Health. Apr 2006;11(4):386-97. doi:10.1111/j.1365-3156.2006.01579.x
  7. White NJ. Anaemia and malaria. Malar J. Oct 19 2018;17(1):371. doi:10.1186/s12936-018-2509-9
  8. Cohee LM, Nankabirwa JI, Greenwood B, Djimde A, Mathanga DP. Time for malaria control in school-age children. Lancet Child Adolesc Health. Aug 2021;5(8):537-538. doi:10.1016/S2352-4642(21)00158-9
  9. Yimgang DP, Buchwald AG, Coalson JE, et al. Population Attributable Fraction of Anemia Associated with Plasmodium falciparum Infection in Children in Southern Malawi. Am J Trop Med Hyg. Jan 04 2021;104(3):1013-1017. doi:10.4269/ajtmh.20-1120
  10. Lalloo DG, Olukoya P, Olliaro P. Malaria in adolescence: burden of disease, consequences, and opportunities for intervention. Lancet Infect Dis. Dec 2006;6(12):780-93. doi:10.1016/S1473-3099(06)70655-7
  11. Hong SC. Malaria: an early indicator of later disease and work level. J Health Econ. May 2013;32(3):612-32. doi:10.1016/j.jhealeco.2013.03.004
  12. WHO. Global Expenditure on Health: Public Spending on the Rise? World Health Organization; 2021.
  13. Andrade MV, Noronha K, Diniz BPC, et al. The economic burden of malaria: a systematic review. Malar J. Oct 05 2022;21(1):283. doi:10.1186/s12936-022-04303-6
  14. Lukwa AT, Mawoyo R, Zablon KN, Siya A, Alaba O. Effect of malaria on productivity in a workplace: the case of a banana plantation in Zimbabwe. Malar J. Dec 03 2019;18(1):390. doi:10.1186/s12936-019-3021-6
  15. Mabe FN, Dafurika T. Averting expenditure on malaria: effects on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District of Ghana. Malar J. Dec 03 2020;19(1):448. doi:10.1186/s12936-020-03521-0
  16. Yerushalmi E, Hunt P, Hoorens S, Sauboin C, Smith R. Exploring the Use of a General Equilibrium Method to Assess the Value of a Malaria Vaccine: An Application to Ghana. MDM Policy & Practice. 2019;
  17. Cutler D, Fung W, Kremer M, Singhal M, Vogl T. Early-life

Malaria Exposure and Adult Outcomes: Evidence from Malaria Eradication in India. American Economic Journal: Applied Economics. 2010;2(2):72-94.

  1. Vorasan N, Pan-Ngum W, Jittamala P, Maneeboonyang W, Rukmanee P, Lawpoolsri S. Long-term impact of childhood malaria infection on school performance among school children in a malaria endemic area along the Thai-Myanmar border. Malar J. Oct 09 2015;14:401. doi:10.1186/s12936-015-0917-7
  2. Barofsky J, Anekwe TD, Chase C. Malaria eradication and economic outcomes in sub-Saharan Africa: Evidence from Uganda. J Health Econ. Dec 2015;44:118-36. doi:10.1016/j.jhealeco.2015.08.002
  3. Etiaba E, Onwujekwe O, Uzochukwu B, Adjagba A. Investigating payment coping mechanisms used for the treatment of uncomplicated malaria to different socio-economic groups in Nigeria. Afr Health Sci. Mar 2015;15(1):42-8. doi:10.4314/ahs.v15i1.6
  4. Jayawardene R. Illness perception: social cost and coping-strategies of malaria cases. Soc Sci Med. Nov 1993;37(9):1169-76. doi:10.1016/0277-9536(93)90256-4
  5. Pluess B, Mueller I, Levi D, King G, Smith TA, Lengeler C. Malaria--a major health problem within an oil palm plantation around Popondetta, Papua New Guinea. Malar J. Apr 08 2009;8:56. doi:10.1186/1475-2875-8-56
  6. Nonvignon J, Aryeetey GC, Malm KL, et al. Economic burden of malaria on businesses in Ghana: a case for private sector investment in malaria control. Malar J. Sep 06 2016;15(1):454. doi:10.1186/s12936-016-1506-0
  7. WHO. Global Health Expenditures Database. Global Health Expenditure Database (who.int)
  8. Sicuri E, Ramponi F, Lopes-Rafegas I, Saúte F. A broader perspective on the economics of malaria prevention and the potential impact of SARS-CoV-2. Nat Commun. May 13 2022;13(1):2676. doi:10.1038/s41467-022-30273-z
  9. Hennessee I, Chinkhumba J, Briggs-Hagen M, et al. Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012. Malar J. Oct 02 2017;16(1):395. doi:10.1186/s12936-017-2038-y
  10. Alonso S, Chaccour CJ, Elobolobo E, et al. The economic burden of malaria on households and the health system in a high transmission district of Mozambique. Malar J. Nov 11 2019;18(1):360. doi:10.1186/s12936-019-2995-4
  11. Watts C, Atieli H, Alacapa J, et al. Rethinking the economic costs of hospitalization for malaria: accounting for the comorbidities of malaria patients in western Kenya. Malar J. Oct 30 2021;20(1):429. doi:10.1186/s12936-021-03958-x
  12. Njau J, Silal SP, Kollipara A, et al. Investment case for malaria elimination in South Africa: a financing model for resource mobilization to accelerate regional malaria elimination. Malar J. Aug 16 2021;20(1):344. doi:10.1186/s12936-021-03875-z
  13. Shretta R, Avancena A, Hatefi A. The economics of malaria control and elimination: a systematic review. Review. Malaria Journal. DEC 12 2016 2016;15ARTN 593. doi:10.1186/s12936-016-1635-5
  14. Sicuri E, Vieta A, Lindner L, Constenla D, Sauboin C. The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya. Malar J. Sep 3 2013;12:307. doi:10.1186/1475-2875-12-307
  15. Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol. Dec 2014;20(4):327-37. doi:10.3350/cmh.2014.20.4.327
  16. Gallup JL, Sachs JD. The economic burden of malaria. Am J Trop Med Hyg. 2001;64(1-2 Suppl):85-96. doi:10.4269/ajtmh.2001.64.85
  17. Sarma N, Patouillard E, Cibulskis RE, Arcand JL. The Economic Burden of Malaria: Revisiting the Evidence. Am J Trop Med Hyg. Dec 2019;101(6):1405-1415. doi:10.4269/ajtmh.19-0386
  18. Bleakley H. Malaria Eradication in the Americas: A Retrospective Analysis of Childhood Exposure. American Economic Journal: Applied Economics. 2010;2(2):1-45.
  19. Smith RD, Keogh-Brown MR, Chico RM, Bretscher MT, Drakeley C, Jensen HT. Will More of the Same Achieve Malaria Elimination? Results from an Integrated Macroeconomic Epidemiological Demographic Model. Am J Trop Med Hyg. Nov 2020;103(5):1871-1882. doi:10.4269/ajtmh.19-0472
  20. Portnoy A, Arcand JL, Clark RA, et al. The potential impact of novel tuberculosis vaccine introduction on economic growth in low- and middle-income countries: A modeling study. PLoS Med. Jul 2023;20(7):e1004252. doi:10.1371/journal.pmed.1004252
  21. WHO. Global Technical Strategy for Malaria 2016-2030. World Health Organization; 2015.
  22. Estill J, Islam T, Houben R, et al. Tuberculosis in the Western Pacific Region: Estimating the burden of disease and return on investment 2020-2030 in four countries. Lancet Reg Health West Pac. Jun 2021;11:100147. doi:10.1016/j.lanwpc.2021.100147
  23. Bloom DE, Chen S, McGovern ME. The economic burden of noncommunicable diseases and mental health conditions: results for Costa Rica, Jamaica, and Peru. Rev Panam Salud Publica. 2018;42:e18. doi:10.26633/RPSP.2018.18
  24. Bloom DE, Chen S, Kuhn M, McGovern ME, Oxley L, Prettner K. The economic burden of chronic diseases: Estimates and projections for China, Japan and South Korea. The Journal of the Economics of Ageing. 2020;17
  25. Chen S, Cao Z, Prettner K, et al. Estimates and Projections of the Global Economic Cost of 29 Cancers in 204 Countries and Territories From 2020 to 2050. JAMA Oncol. Apr 01 2023;9(4):465-472. doi:10.1001/jamaoncol.2022.7826
  26. Chen S, Kuhn M, Prettner K, Bloom DE. The macroeconomic burden of noncommunicable diseases in the United States: Estimates and projections. PLoS One. 2018;13(11):e0206702. doi:10.1371/journal.pone.0206702
  27. R: A language and environment for statistical computing. Version 4.3. R Foundation for Statistical Computing; 2021. https://www.R-project.org/.
  28. R Studio: Integrated Development for R. RStudio; 2020. http://www.rstudio.com/ .
  29. Feenstra RC, Inklaar R, Timmer MP. The Next Generation of the Penn World Table. American Economic Review. 2015;105(10):3150-3182.
  30. ILOSTAT. Statistics on the population and labour force. Geneva: International Labour Organization; 2015 
  31. WHO. Global Health Observatory 2019: Disease burden by Casue, Age, Sex, by Country and by Region 2000-2019. Global Health Observatory (who.int)
  32. Patouillard E, Griffin J, Bhatt S, Ghani A, Cibulskis R. Global investment targets for malaria control and elimination 2016-2030. BMJ Global Health. 2016;(2 (2) e000176)doi:DOI: 10.1136/bmjgh-2016-000176
  33. Griffin JT, Bhatt S, Sinka ME, et al. Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study. Lancet Infect Dis. Apr 2016;16(4):465-72. doi:10.1016/S1473-3099(15)00423-5
  34. Sauerborn R, Shepard DS, Ettling MB, Brinkmann U, Nougtara A, Diesfeld HJ. Estimating the direct and indirect economic costs of malaria in a rural district of Burkina Faso. Trop Med Parasitol. Sep 1991;42(3):219-23.
  35. Guiguemde TR, Coulibaly N, Coulibaly SO, Ouedraogo JB, Gbary AR. [An outline of a method for estimating the calculated economic cost of malaria cases: its application to a rural area in Burkina Faso (Western Africa)]. Trop Med Int Health. Jul 1997;2(7):646-53. Esquisse d'une methode d'estimation du cout economique chiffre des acces palustres: application a une zone rurale au Burkina Faso (Afrique de l'Ouest). doi:10.1046/j.1365-3156.1997.d01-351.x
  36. The World Bank. DataBank, World Development Indicators.
  37. UN Population Division. World Population Prospects. New York: United Nations; 2015.
  38. Chima RI, Goodman CA, Mills A. The economic impact of malaria in Africa: a critical review of the evidence. Health Policy. Jan 2003;63(1):17-36. doi:Pii S0168-8510(02)00036-2

Doi 10.1016/S0168-8510(02)00036-2

  1. Asenso-Okyere WK, Dzator JA. Household cost of seeking malaria care. A retrospective study of two districts in Ghana. Soc Sci Med. Sep 1997;45(5):659-67. doi:10.1016/s0277-9536(96)00383-8
  2. Sauerborn R, Nougtara A, Hien M, Diesfeld HJ. Seasonal variations of household costs of illness in Burkina Faso. Soc Sci Med. Aug 1996;43(3):281-90. doi:10.1016/0277-9536(95)00374-6
  3. Feachem RGA, Chen I, Akbari O, et al. Malaria eradication within a generation: ambitious, achievable, and necessary. Lancet. Sep 21 2019;394(10203):1056-1112. doi:10.1016/S0140-6736(19)31139-0
  4. Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
  5. Bertram MY, Edejer TTT. Introduction to the Special Issue on "The World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update". Int J Health Policy Manag. Nov 01 2021;10(11):670-672. doi:10.34172/ijhpm.2021.105
  6. Bertram MY, Lauer JA, Stenberg K, Edejer TTT. Methods for the Economic Evaluation of Health Care Interventions for Priority Setting in the Health System: An Update From WHO CHOICE. Int J Health Policy Manag. Nov 01 2021;10(11):673-677. doi:10.34172/ijhpm.2020.244

Articles in Press, Accepted Manuscript
Available Online from 05 September 2023
  • Receive Date: 27 January 2022
  • Revise Date: 13 July 2023
  • Accept Date: 04 September 2023
  • First Publish Date: 05 September 2023