Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control Matteo Pedercini1, Santiago Movilla Blanco1,2, Birgit Kopainsky2,3* 1 Millennium Institute, Washington, District of Columbia, United States of America, 2 System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway, 3 Flury&Giuliani GmbH, Zurich, Switzerland Abstract Introduction: DDT is considered to be the most cost-effective insecticide for combating malaria. However, it is also the most environmentally persistent and can pose risks to human health when sprayed indoors. Therefore, the use of DDT for vector control remains controversial. Methods: In this paper we develop a computer-based simulation model to assess some of the costs and benefits of the continued use of DDT for Indoor Residual Spraying (IRS) versus its rapid phase out. We apply the prototype model to the aggregated sub Saharan African region. For putting the question about the continued use of DDT for IRS versus its rapid phase out into perspective we calculate the same costs and benefits for alternative combinations of integrated vector management interventions. Results: Our simulation results confirm that the current mix of integrated vector management interventions with DDT as the main insecticide is cheaper than the same mix with alternative insecticides when only direct costs are considered. However, combinations with a stronger focus on insecticide-treated bed nets and environmental management show higher levels of cost-effectiveness than interventions with a focus on IRS. Thus, this focus would also allow phasing out DDT in a cost- effective manner. Although a rapid phase out of DDT for IRS is the most expensive of the tested intervention combinations it can have important economic benefits in addition to health and environmental impacts that are difficult to assess in monetary terms. Those economic benefits captured by the model include the avoided risk of losses in agricultural exports. Conclusions: The prototype simulation model illustrates how a computer-based scenario analysis tool can inform debates on malaria control policies in general and on the continued use of DDT for IRS versus its rapid phase out in specific. Simulation models create systematic mechanisms for analyzing alternative interventions and making informed trade offs. Citation: Pedercini M, Movilla Blanco S, Kopainsky B (2011) Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control. PLoS ONE 6(11): e27771. doi:10.1371/journal.pone.0027771 Editor: James G. Beeson, Burnet Institute, Australia Received May 18, 2011; Accepted October 25, 2011; Published November 30, 2011 Copyright: 2011 Pedercini et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study benefited from a grant from Biovision Foundation (www.biovision.ch). In addition, part of the work done by one author (BK) was supported by the Swiss National Science Foundation under a Fellowship for Advanced Researchers. The views and conclusions expressed in this paper are those of the authors alone and do not necessarily reflect the views of the Swiss National Science Foundation. The funders had no role in study design, data collection and analysis, or decision to publish. Competing Interests: The authors have read the journal’s policy and have the following conflicts. One of the authors is an employee at a commercial company (Flury&Giuliani GmbH). This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials. * E-mail: birgit.kopainsky@flury-giuliani.ch Introduction Malaria is one of the world’s most deadly diseases, and it is especially dangerous for children and pregnant women. Every year around 780’000 people die from malaria and more than 225 million cases of clinical malaria are reported [1]. Around 90% of these cases happen in sub Saharan Africa (SSA) [2]. In addition to the death toll, malaria has strong implications for development. Malaria has a relevant impact on workers’ productivity, thus reducing a country’s economic growth prospects. Malaria also absorbs a large amount of funds that could otherwise be used for investment in productive activities. In addition, malaria reduces students’ attendance at school, thus affecting their education and productivity in the long run. Therefore, countries where malaria is endemic are often stuck in a malaria trap, where malaria is at the same time a cause for and an effect of slow development [3]. Malaria interventions focus on both, case management (treatment) and prevention [4]. Successful case management is based on prompt disease recognition and on the use of adequate and high-quality therapies for eradication of the parasite species causing malaria. On the other hand, methods for prevention are very diverse. Excluding blood transfusion and congenital trans- mission, Anopheline mosquito species are the only known malaria vector. Almost all preventive measures are thus intended to avoiding mosquito bites to humans. Vector control measures include environmental, mechanical, biological, and chemical as well as structural adaptations that can be allocated to two broad categories [4]: Indoor Residual Spraying (IRS) and Insecticide PLoS ONE | www.plosone.org 1 November 2011 | Volume 6 | Issue 11 | e27771