Estimating the opportunity cost of seasonal malaria chemoprevention implementation in Burkina Faso, Mali and Senegal.

BackgroundSeasonal malaria chemoprevention (SMC) is a widely implemented malaria prevention strategy for children under five in the Sahel and sub-Sahel regions of Africa. This study aimed to estimate the full opportunity costs associated with SMC implementation in Mali, Burkina Faso and Senegal, addressing a gap in existing research that often focused solely on health system costs.Using a repeated descriptive cross-sectional design, data were collected from April to November 2022 during two SMC cycles. The study involved 376 caregivers in Mali, 398 in Senegal and 373 in Burkina Faso, alongside 127 community health volunteers in Mali, 41 in Senegal and 97 in Burkina Faso. Health worker supervisors recruited were 96 in Mali, 96 in Senegal and 42 in Burkina Faso. Data collection occurred across 15 health facilities in Burkina Faso and Senegal and 16 health facilities in Mali across four districts within each country.Both financial and economic costs were analysed using an ingredients approach, encompassing direct and indirect costs. Financial costs per SMC dose were estimated at US$0.99 in Mali, US$1.42 in Burkina Faso and US$1.51 in Senegal. Economic costs per dose were US$3.02 in Senegal, US$3.14 in Burkina Faso and US$2.96 in Mali. Total annual costs per child receiving four doses ranged from US$3.97 to US$6.05 for financial costs and US$11.85 to US$12.57 for economic costs. Notably, indirect costs, mainly related to productivity losses among caregivers, volunteers and healthcare workers, constituted 50%-66% of total economic costs.The findings highlight the economic cost of SMC implementation, driven largely by productivity losses of caregivers and volunteers which have often been overlooked in policy decisions. This study highlights the need for comprehensive cost assessments in malaria control programmes to inform effective decision-making.