Cost and Return on Investment of the Mandla Malaria Elimination Demonstration Project: Health and Economic Modelling for the National Malaria Elimination Goal

Abstract Background: Malaria elimination is among the most cost-effective public health strategies, with strong evidence for economic and societal benefits. India has achieved an ~80% reduction in malaria cases between 2015 and 2023. At this time, 37 districts continue to report an Annual Parasite Incidence (API) greater than one and remain high-priority for intensified interventions. Subnational analyses are needed to guide resource allocation and sustain progress. Methods : The Malaria Elimination Demonstration Project (MEDP) was implemented in Mandla, a high-endemic tribal district in Madhya Pradesh, through a public–private partnership. Intensified surveillance, case management, vector control, and community engagement were deployed. A difference-in-difference regression model using data from 2001 to 2023 compared Mandla with four control districts. An economic evaluation used a cost-of-illness framework to estimate avoided household costs, productivity losses, the value of lives saved, personal protection expenditures, and reduced health system costs. Sensitivity analyses were conducted using Monte Carlo simulations. Results: MEDP reduced malaria incidence to near zero, averting ~998 cases annually. The intervention prevented household and health system costs totalling INR 73.6 million (US$0.87 million) annually, with a cost–benefit ratio of 1.64 and an ROI of 64%. Benefits extend beyond health, with tourism in the Kanha Tiger Reserve increasing faster than the national average following the MEDP. Conclusion: Mandla’s experience demonstrates that elimination is feasible and economically advantageous. Scaling this model to India’s high-priority districts with an API greater than one could accelerate national elimination goals while delivering broad developmental benefits. The project was supported through a public–private partnership involving the Indian Council of Medical Research, the Government of Madhya Pradesh, and the Foundation for Disease Elimination and Control of India.