A Smart Investment: The Health, Education, and Economic Returns of Malaria Chemoprevention in School-Aged Children Across Ten High-Burden Countries

Malaria imposes societal costs beyond health, including substantial effects on education, yet economic evaluations often overlook these broader impacts. We conducted a cross-sectoral benefit-cost analysis of malaria chemoprevention in school-aged children (SAC) across ten high-burden sub-Saharan African countries. Using recent trial data, we estimated impacts on malaria morbidity, mortality, school absenteeism, and literacy. The intervention was projected to cost $422 million and generate $5.7 billion in societal net benefits, yielding a benefit-cost ratio (BCR) of 14.3. Country-level BCRs ranged from 3.71 to 39.5, with the highest returns in Nigeria. Results were sensitive to drug choice, discount rate, and valuation of education benefits. When using school quality metrics (estimated via Learning-Adjusted Years of Schooling (LAYS)), BCRs increased up to 100-fold compared to estimates based on school quantity alone. Probabilistic sensitivity analysis yielded a mean simulated BCR of 11.00 (95% CI: 10.89-11.11), with a >95% probability of being cost-beneficial at a BCR threshold of 3. This study advances the evidence base for malaria chemoprevention in SAC, highlighting its dual health and educational benefits. These findings offer policymakers and funders strong evidence to prioritize malaria chemoprevention in SAC as a high-value investment in both health and human capital in malaria-endemic regions.