ACT Now or Later: The Economics of Malaria Resistance

In the past, malaria control efforts in sub-Saharan Africa have relied on a combination of vector control and effective treatment using chloroquine. With increasing resistance to chloroquine, attention has now turned to alternative treatment strategies to replace this failing drug. Although there are strong theoretical arguments in favor of switching to more expensive artemisinin-based combination treatments (ACTs), the validity of these arguments in the face of financial constraints has not been previously analyzed. In this paper, we use a bioeconomic model of malaria transmission and evolution of drug resistance to examine questions of optimal treatment strategy and coverage when drug resistance places an additional constraint on choices available to the policymaker. Our main finding is that introducing ACTs sooner is more economically efficient if the planner had a relatively longer time horizon. However, for shorter planning horizons, delaying the introduction of ACTs is preferable.