An Investment Case for the Scale-up and Use of Insecticide-Treated Nets Halfway into the SDG Targets

This article examines a policy of scaling up LLINs by 10 percentage points from 2020 levels with a 90% cap in the 29 highest-burden countries in Africa along with social and behavioral change (SBC) and information education and communication (IEC) campaigns to increase the use and effectiveness of LLINs. The incremental cost of this scenario compared to a baseline of maintaining malaria interventions at 2020 levels has a present-day (2023) value of 5.7 billion US$ 2021 discounted at 8% over the period 2023–2030 (undiscounted starting at US$ 416 million in 2023 increasing to US$ 1.4 billion in 2030). This investment will prevent 1.07 billion clinical cases and save 1,337,069 lives. With standardized Copenhagen Consensus Center assumptions, the mortality benefit translates to a present value of US$ 225.9 billion. The direct economic gain is also substantial: the incremental scenarios lead to US$ 7.7 billion in reduced health system expenditure from the reduced treatment of cases, a reduction in the cost of delivering malaria control activities, and reduced household out-of-pocket expenses for malaria treatment. The productivity gains from averted employee and caretaker absenteeism and presenteeism add benefits with a present value of US$ 41.7 billion. Each dollar spent on the incremental scenario delivers US$ 48 in social and economic benefits.