We guess that the full programmatic costs will be driven by the costs of providing technical assistance to implement IPTi, including things like costs of stakeholder engagement, health provider training, monitoring, and procurement and supply chain management. Thus we have gone with a cost estimate that is much higher than the costs of the drugs alone. We plan to refine this estimate as we investigate specific funding opportunities.

To get a rough estimate of costs per targeted child from costs per child receiving at least one dose of IPTi, we use take-up of first dose of IPTi by 9 months as a proxy for take-up of any dose of IPTi. This may not be accurate, but we expect to have much better information on costs as we're looking into specific funding opportunities.

Postneonatal mortality rate in 2017 in the Democratic Republic of Congo (DRC). From GBD Results Tool. We rely on data from the DRC for illustration for now, as it is a country with a high burden of malaria and low malaria seasonality and may be similar to geographies where we would consider funding IPTi. As we investigate specific funding opportunities, we plan to revisit the CEA for the countries we are considering.

Assuming mortality rate stays constant between 1 and 12 months of age.

Assuming 12 months for now, but this will depend on the specific funding opportunities we look into. Under the current WHO guidelines, the last round of standard IPTi occurs at 9 months, and SP provides around 1 month of protection from when it's taken. However, we are considering proposals to add additional touchpoints for IPTi that would cover an infant up to 1 year (and possibly up to 2 years) of age, so we use coverage up to 12 months as a placeholder guess.

Adjusted from postneonatal mortality to get mortality rate within the age range over which IPTi provides protection.

Data on mortality in DRC in 2017, from the GBD Results Tool.

Data on mortality in DRC in 2017, from the GBD Results Tool.

Data on mortality in DRC in 2017, from the GBD Results Tool.

IPTi coverage in Esu et al. 2019 underlying trials

7 of the 9 trials were using SP, the IPTi drug of choice. The effect size on the SP subgroup (0.78) is very close to the effect size including all 9 trials (0.76), so we don't adjust for drug combination used in the studies.

Based on coverage achieved in Sierra Leone pilot.

Assuming a linear relationship between treatment effect and number of doses received

Subjective. See report for discussion of why we believe the research establishing effects on clinical malaria cases is of high quality.

Adjusting for drug resistance. See reasoning behind EV adjustment.

Percentage reduction in clinical malaria among children in targeted age range, after IV/EV adjustments

Assumes malaria mortality is reduced by the same fraction as malaria episodes. This is what our cost-effectiveness analysis of seasonal malaria chemoprevention (SMC) does. See existing discussion.

From Seasonal Malaria Chemoprevention (SMC) CEA

See calculations for 2020 moral weights for under-1 and over-1 deaths from malaria.

Adjustment to account for higher proportion of people being covered in trial than in targeted population

See calculations and explanation of adjustment.

See calculations for 2020 moral weights for under-1 and over-1 deaths from malaria.

Assuming proportion of value coming from mortality vs. developmental effects is the same as in the SMC CEA. Not sure how this changes with different age distribution here.

Adjustments taken from the SMC CEA. Excluded the adjustment for drug resistance, since that is accounted for in the external validity adjustment.

Only includes adjustments for excluded effects that directly affect mortality.

Seems unlikely that children are getting preventative treatment from another source.

We guess that drugs will be purchased from World Health Organization-qualified manufacturers.

To adjust for potential drug wastage. We would guess that drug wastage may be a bigger concern for a program implemented via technical assistance within health systems than for our top charities, since an implementer would have less direct control over drug procurement and delivery. Once we investigate specific funding opportunities, drug wastage would likely be incorporated explicitly into our cost estimates.

Guess. Our impression is that it's unlikely charities would receive funding for IPTi in the short term from other funders.