Costs of Malaria Monitoring Measures
Costs of case detection and treatment: Table 3 shows that the case detection and treatment cost constituted 66.62% of the total cost (404,998,744.36 yuan = USD 58,319,819.19).
Table 3
Total costs of monitoring measures during the malaria elimination stage in Fujian Province
Project
|
Essential factor
|
Calculation process
|
Total cost (yuan)
|
Total cost (USD)
|
Case detection and treatment
|
Professionals salaries
|
135,232 × 2,210 + 335,895 × 170 + 385,879 × 85
|
388,764,585.00
|
55,982,100.24
|
Blood test costs
|
10 × (1,006,080 + 191,395)
|
11,974,750.00
|
1,724,364.00
|
Direct medical costs
|
319.35 × 1,192
|
380,665.20
|
54,815.79
|
Direct non-medical costs
|
218.94 × 1,192 × 2
|
524,336.96
|
75,504.52
|
Missed work costs
|
1,407.05 × 1,192 × 2
|
3,354,407.20
|
483,034.64
|
Subtotal
|
|
404,998,744.36
|
58,319,819.19
|
Epidemic monitoring
|
Professional salaries
|
471,127 × 74 + 385,879 × 64
|
59,559,654.00
|
8,576,590.18
|
Media monitoring costs
|
1000 × 6 ×(37 + 32)
|
414,000.00
|
59,616.00
|
Anti-mosquito drugs costs
|
70,000 × 5 + 50,000 × 6 + 30,000 × 4
|
770,000
|
110,880.00
|
Travel allowances
|
80 × 2 × 544 + 180 × 2 × 648
|
320,320.00
|
46,126.08
|
Subtotal
|
|
61,063,974.00
|
8,793,212.26
|
Training and meetings
|
Training costs
|
130 × 3 × 3121 + 400 × 3 × 15421
|
19,722,390.00
|
2,840,024.16
|
Meeting costs
|
19,722,390.00 × 5%
|
9,861,195.00
|
1,420,012.08
|
Subtotal
|
|
29,583,585.00
|
4,260,036.24
|
Health education
|
Health education costs
|
20,000 × 15
|
300,000.00
|
43,200.00
|
Professional salaries
|
857,006 × 94
|
80,558,564.00
|
11,600,433.22
|
Labor costs
|
50 × 94 × 15
|
70,500.00
|
10,152.00
|
Subtotal
|
|
80,929,064.00
|
11,653,785.22
|
Supervision
and assessment
|
Material costs
|
40 × 188 × 15
|
112,800.00
|
16,243.20
|
Professional salaries
|
857,006 × 36
|
30,852,216.00
|
4,442,719.10
|
Travel allowances
|
(720 + 1080) × 188
|
338,400.00
|
48,729.60
|
Subtotal
|
|
31,303,416.00
|
4,507,691.90
|
Total cost
|
|
|
607,878,783.36
|
87,534,544.80
|
For the period 2005–2009, blood tests were carried out by two lab professionals in each town. Hence, the data shows that, across the 105 towns, a total of 2,210 lab professionals were required for this period. Subsequently, for the period 2010–2015, blood tests were carried out by two lab professionals in each county. Thus, for 85 counties, there were 170 lab professionals. Finally, for the period 2016–2019, blood tests were carried out by one lab professional in each county. Hence, there were 85 lab professionals in 85 counties.
Accordingly, total lab professional salary costs were 388,764,585.00 yuan (USD 55,982,100.24).
The required annual blood test rate was not less than 2/100 in Nanping and Sanming, not less than 5/1,000 in the southern area, and not less than 1/1,000 in other cities. In 2005–2009, the number of patients was 1,006,080. In the period 2010–2019, the required annual blood test rate was not less than 5/10,000 in Fujian and the number of patients was 191,395.
Accordingly, the total blood test cost was 11,974,750.00 yuan (USD 1,724,364.00).
Overall, 1,192 cases were reported during the malaria elimination stage (2005–2019). The total costs were as follows: direct medical cost was 380,665.20 yuan (USD 54,815.79), direct non-medical cost was 524,336.96 yuan (USD 75,504.52), and missed work cost was 3,354,407.20 yuan (USD 483,034.64).
Cost of epidemic monitoring: Table 3 shows that the epidemic monitoring cost constituted 10.05% (61,063,974.00 yuan = USD 8,793,212.26) of the total cost.
The monitoring work was carried out with two professionals at each site and there were five sites for floating population communities during 2005–2019. There were 15 sites in the southern area and 22 sites in the northwestern area. Hence, with two professionals in each site, there were 74 professionals in 37 sites from 2005 to 2015. Subsequently, for the period 2016–2019, there were 20 sites in Nanping and Sanming, and 7 sites in the other cities, that is, 64 professionals in 32 sites.
The total cost of professionals’ salaries was 59,559,654.00 yuan (USD 8,576,590.18). In addition, the Anopheles density is monitored six times per year. Therefore, total media monitoring costs was 414,000.00 yuan (USD 59,616.00);
The anti-mosquito drugs costs were 70,000 yuan (USD 10,080.00) per year between 2005 and 2009), 50,000 yuan (USD 7,200.00) per year from 2010 to 2015, and 30,000 yuan (USD 4,320.00) per year between 2016 and 2019.
Hence, the total anti-mosquito drug cost was 770,000 yuan (USD 110,880.00).
The cases were investigated and verified by two professionals. This incurred a cost for professional travel allowance of 320,320.00 yuan (USD 46,126.08).
Cost of training and meetings: Table 3 shows that the training and meeting cost was 4.87% (29,583,585.00 yuan = USD 4,260,036.24) of total costs. Each training session lasted for approximately three days. In total, 3,121 professionals attended training in the period from 2005–2013 and 15,421 professionals attended between 2014 and 2019.
Hence, the total training cost was 19,722,390.00 yuan (USD 2,840,024.16) and the total meeting cost is estimated at 9,861,195.00 yuan (USD 1,420,012.08).
Cost of health education: Table 3 shows that the health education cost was 13.31% (80,929,064.00 yuan = USD$ 11,653,785.22) of total costs. Ninety-four professionals participated in health education every year. The health education activities cost was estimated at 20,000 yuan (USD 2,880.00) every year. Thus, the total health education cost was 300,000.00 yuan (USD 43,200.00). Further, the total professional salary cost for health education was 80,558,564.00 yuan (USD 11,600,433.22) and the total labor cost was 70,500.00 yuan (USD 10,152.00).
Cost of supervision and assessment: Table 3 shows that the supervision and assessment cost was 5.15% (31,303,416.00 yuan = USD$ 4,507,691.90) of the total cost. Thirty-six professionals conducted 188 supervisions and assessments every year. The total material cost was 112,800.00 yuan (USD 16,243.20), the total professional salary cost was 30,852,216.00 yuan (USD 4,442,719.10), and the associated total professional travel allowance cost was 338,400.00 yuan (USD 48,729.60).
Table 3 shows that the total cost of monitoring measures during the malaria elimination stage from 2005–2019 was 607,878,783.36 yuan (USD 87,534,544.80). The proportions of monitoring measure costs are shown in Fig. 1.
Benefits Achieved in the Malaria Elimination Stage
Economic benefits: Without effective monitoring and control measures, the spread of a malaria epidemic would be very fast and seriously damage human health. All cases would need to be treated with anti-malaria drugs in hospitals. The control incidence rate in this study, which is 238.25/10,000, is based on the highest incidence of malaria in the years since 1972 [9]. In the malaria elimination stage, the permanent population of Fujian Province was 563.38 million, so the number of potential cases = 238.25/10000 × 563380000 = 13,422,529. There were 1,192 cases reported during this stage, so 13,421,337 cases of malaria may have been avoided as a result of the monitoring measures.
Accordingly, the direct medical benefits of avoiding hospitalization can be calculated as = 319.35 × 13,421,337 = 4,286,103,970.95 yuan (USD 617,198,971.82).
The direct non-medical benefits of avoiding hospitalization can be calculated as = 218.94 × 13,421,337 × 2 = 5,876,935,045.56 yuan (USD 846,278,646.56).
The benefit which accrues from not missing work due to hospitalization is = 1,407.05 × 13,421,337 × 2 = 37,768,984,451.60 yuan (USD 5,438,733,761.03).
Social benefits: Social benefits accrue when the professionals (clinicians, monitors, and lab professionals) improve the province’s malaria monitoring ability through training. In the malaria elimination stage, the benefit of improving monitoring ability = 250 × 18,542 = 4,635,500.00 yuan (USD 667,512.00).
To calculate the value of the benefit of improving health, the health care cost we estimated that residents were willing to spend to avoid malaria, which was 882.83 yuan (USD 127.13), needs to be considered. Thus, the value of the benefit of improved health can be calculated as 882.83 × 13,421,337 = 11,848,758,943.70 yuan (USD 1,706,221,287.89).
It was assumed that, as a result of the health education activities, all residents would acquire prevention knowledge and avoid malaria infection. Combined with the survey results [10], it was estimated that the social benefit of this education was 100 yuan (USD 14.40) per capita. Accordingly, the total benefit of improving health protection awareness was calculated as 100 × 563,380,000 = 56,338,000,000.00 yuan (USD 811,267,200.00).
In sum, the total benefit achieved in the malaria elimination stage was 116,123,417,911.81 yuan (USD 16,721,772,179.30) (Fig. 2). As shown in Table 4, the economic benefit was 22.61% (47,932,023,468.11 yuan = USD 6,902,211,379.41) of the total amount. The social benefit constituted 77.39% (164,055,441,379.92 yuan = USD 23,623,983,558.71) of the total.
Table 4
Total benefits of the malaria elimination stage in Fujian Province
Project
|
Essential factor
|
Benefit (yuan)
|
Benefit (USD)
|
Proportion (%)
|
Economic benefit
|
Direct medical benefit of avoiding hospitalization
|
4,286,103,970.95
|
617,198,971.82
|
3.69
|
Direct non-medical benefit of avoiding hospitalization
|
5,876,935,045.56
|
846,278,646.56
|
5.06
|
Missed work benefit of avoiding hospitalization
|
37,768,984,451.60
|
5,438,733,761.03
|
32.52
|
Subtotal
|
47,932,023,468.11
|
6,902,211,379.41
|
22.61
|
Social benefit
|
Benefit of improving monitoring ability
|
4,635,500.00
|
667,512.00
|
0.01
|
Benefit of improving health
|
11,848,758,943.70
|
1,706,221,287.89
|
10.20
|
Benefit of improving health protection awareness
|
56,338,000,000.00
|
811,267,200.00
|
48.52
|
Subtotal
|
164,055,441,379.92
|
23,623,983,558.71
|
77.39
|
Total benefit
|
1,161,23,417,911.81
|
16,721,772,179.30
|
100.00
|
Cost-benefit Analysis of Malaria Monitoring
In the malaria elimination stage, the permanent population of Fujian Province was 563.38 million and the total cost of monitoring measures was 607,878,783.36 yuan (USD 87,534,544.80). This means that the cost of malaria monitoring per resident was 1.08 yuan (USD 0.16). The total benefit achieved in the malaria elimination stage was 116,123,417,911.81 yuan (USD 16,721,772,179.30), which means the benefit of malaria monitoring for each resident was 206.12 yuan (USD 29.68). Hence, the results show that the malaria monitoring measure cost per capita was less than the benefit per capita in Fujian Province. Hence, the effect of the malaria monitoring work was very beneficial. Specifically, BCR = B / C = 116,123,417,911.81 / 607,878,783.36 = 191.03 and NB = B - C = 116,123,417,911.81–607,878,783.36 = 115,515,539,128.45 yuan (USD 16,634,237,634.50).