Economic burden of malaria in the Brazilian Amazon from a societal perspective

Malaria remains a global health challenge, imposing a substantial economic burden on health systems and society. Comprehensive assessments of this burden have been limited. This study aimed to provide a detailed estimate of the economic burden of malaria in the Brazilian Amazon. Public health expenditures were derived from a previous study. Direct, and indirect household costs and Health-Related Quality-of-Life (HRQoL) losses were estimated using a household survey conducted in nine municipalities in five states of the Brazilian Amazon. Expenditure data were collected from 1,131 individuals who experienced a malaria episode between January 2019 and May 2022. All costs were monetized and converted to 2024 purchasing power parity US dollars (PPP-USD). The total economic burden of malaria in the Amazon in 2019 was approximately US$181.9 million PPP-USD. The Unified Health System (SUS) bore the largest share (72.4%), which was allocated primarily to control and prevention activities. The states of Amazonas, Pará, and Roraima bore the highest total burden. Household burden was predominantly driven by indirect and mortality costs, and HRQoL losses. Major limitations of the study included convenience sampling and potential recall bias regarding expenditures; the latter was mitigated by surveying items and quantities rather than monetary values. This study offers a comprehensive and unparalleled assessment of the economic burden of malaria, providing a foundation for developing effective malaria control policies at the national and local levels in Brazil. Our findings underscore the critical role of the SUS in shielding families from direct medical costs, while revealing the substantial indirect costs, health-related quality-of-life losses, and mortality-related losses borne by households. These insights are essential for informing resource allocation and strengthening malaria control and elimination strategies in the Brazilian Amazon. The study provides a conceptual framework for estimating the economic cost of malaria that can be adapted to other malaria-endemic countries.