For over a decade, malaria treatment in sub-Saharan Africa and other endemic regions has been in crisis. Conventional anti malarial drugs such as chloroquine and sulphadoxine/pyrimethamine (SP) have become increasingly obsolete in the face of growing drug resistance. Current debates favour using artemisinin-based combination therapy (ACT) regimens. ACTs are highly efficacious and offer potential to check the progression of drug resistance. They are also expensive with prices as much as 10 to 20 times greater than conventional monotherapies. The development of anti malarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and a non-drug cost associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependent on clinical diagnosis. Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. 

Joseph D Njau, Catherine A Goodman et al; 2008, 7:4 doi: 10.1186/1475-2875-7-4