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@article{mohan_estimating_2026,
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title = {Estimating {System}-{Wide} {Healthcare} {Costs} {Using} a {Health} {System} {Model}: {Application} to the {Thanzi} {La} {Onse} {Model} of {Malawi}},
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issn = {1175-5652, 1179-1896},
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shorttitle = {Estimating {System}-{Wide} {Healthcare} {Costs} {Using} a {Health} {System} {Model}},
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url = {https://link.springer.com/10.1007/s40258-026-01030-w},
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doi = {10.1007/s40258-026-01030-w},
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abstract = {Objectives Modelling approaches that consider system-wide delivery platforms rather than single diseases can be instrumental in economic evaluation and forward-looking policy formulation. This study develops a costing approach tailored to the Thanzi La Onse (TLO) model of Malawi’s healthcare system, with general applicability to other health system models.
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Methods We developed a mixed-method costing approach to estimate the total cost of healthcare delivery (excluding highlevel administrative costs) in Malawi using the TLO model, from a healthcare provider perspective. Through iterative adjustments of key parameters, we aligned model-based estimates as closely as possible with real-world expenditure and budget data. Costs were projected for 2023–2030 under alternative scenarios of health system capacity.
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Results A comparison with expenditure and budget data suggests our costing method is broadly reliable for the conditions captured by the model, though some mismatches remain owing to data limitations and definitional inconsistencies. Under current system capacity, total healthcare delivery costs for 2023–2030 were estimated at 2.83 billion US dollars [95\% uncertainty interval (UI), \$2.80–\$2.87 billion], excluding non-medical infrastructure and administrative costs, averaging \$390.98 million [\$385.92–\$396.71 million] annually or \$16.89 [\$16.75–\$17.08] per capita. Scenario analysis highlighted strong interdependencies within the health system. Improving consumable availability alone increased consumables costs by 4.63\%, while expanding human resources for health (HRH) alone increased them by 1.43\%. When both HRH and consumable availability were expanded together, consumable costs rose by 5.93\%, a combined effect larger than either change alone, illustrating how bottlenecks in one component constrain the impact of improvements in another.
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Conclusions Mixed-method costing using health system models is a feasible and robust method to estimate and forecast healthcare delivery costs. Clarifying assumptions and limitations can improve their utility for economic analyses and evidence-based planning in the health sector.},
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language = {en},
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urldate = {2026-05-06},
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journal = {Applied Health Economics and Health Policy},
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author = {Mohan, Sakshi and Chagoma, Newton and Walker, Simon and Arega, Christian Abraham and Chalkley, Martin and Collins, Joseph and Connolly, Emilia and Colbourn, Tim and Janoušková, Eva and Mangal, Tara D. and Manthalu, Gerald and Mfutso-Bengo, Joseph and Molaro, Margherita and Nkhoma, Dominic and Phillips, Andrew and Sharma, Lalit and She, Bingling and Tafesse, Wiktoria and Twea, Pakwanja Desiree and Revill, Paul and Hallett, Timothy B.},
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month = may,
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year = {2026},
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keywords = {Overview of the model},
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}
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@misc{janouskova_cost-effectiveness_2026,
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title = {Cost-effectiveness of addressing constraints in childhood acute malnutrition management in {Malawi} using the \textit{{Thanzi} {La} {Onse}} health system simulation framework},
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copyright = {http://creativecommons.org/licenses/by/4.0/},
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url = {http://medrxiv.org/lookup/doi/10.64898/2026.03.05.26347696},
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doi = {10.64898/2026.03.05.26347696},
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abstract = {Background
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abstract = {Abstract
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Background
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Acute malnutrition remains a major public health challenge among children under five in Malawi due to undetected and untreated cases. While several policies and programmes are in place, they face significant resource input and implementation constraints. In this study, we evaluate the potential health impact and cost-effectiveness of three interventions designed to address constraints along the care pathway in childhood acute malnutrition management. These include improving early recognition of symptoms by caregivers, increasing attendance at routine growth monitoring visits through community outreach, and scaling up the availability of therapeutic food supplements.
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Methods and Findings
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We use a newly developed model representing the natural history and management of acute malnutrition, implemented within the
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Thanzi La Onse
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(TLO) dynamic individual-based simulation framework, which captures the public health system in Malawi. Each of the three interventions is assessed both individually and in combination, translated into seven scenarios which we evaluate in comparison to the status quo. The optimal strategy combines two interventions, improved caregiver awareness of early symptoms with increased availability of therapeutic food supplements. Over five years, this strategy is predicted to avert 840,470 (95\% CI: 682,057–998,883) DALYs with total incremental costs of \$34 million. This corresponds to an annual health expenditure increase of \$0.32 per capita. At a cost-effectiveness threshold of \$76 per DALY averted, the strategy results in an incremental net health benefit of 394,252 (95\% CI: 235,839–552,665) DALYs averted.
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Conclusions
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The cost-effective strategy for addressing constraints in childhood acute malnutrition management is simultaneously improving caregiver recognition of early symptoms and expanding therapeutic food supplement availability. Out of the seven scenarios evaluated, this integrated approach was found to be the optimal strategy within the Malawian public health system, yielding substantial health at modest costs. These findings provide critical evidence to inform national policy and guide investment prioritisation for the management of childhood acute malnutrition.},
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language = {en},
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number = {1},
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urldate = {2025-11-06},
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journal = {Scientific Reports},
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publisher = {Nature Publishing Group},
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author = {Murray-Watson, Rachel E. and Molaro, Margherita and Murray-Watson, Rebecca J. and Mohan, Sakshi and She, Bingling and Mangal, Tara and Collins, Joseph H. and Bhatia, Sangeeta and Janoušková, Eva and Hallett, Timothy B.},
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month = oct,
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year = {2025},
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note = {Publisher: Nature Publishing Group},
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keywords = {Other analyses},
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pages = {37896},
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}
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number = {8},
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urldate = {2025-08-27},
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journal = {PLOS Medicine},
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publisher = {Public Library of Science},
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author = {Molaro, Margherita and Revill, Paul and Chalkley, Martin and Mohan, Sakshi and Mangal, Tara D. and Colbourn, Tim and Collins, Joseph H. and Graham, Matthew M. and Graham, William and Janoušková, Eva and Manthalu, Gerald and Mnjowe, Emmanuel and Mulwafu, Watipaso and Murray-Watson, Rachel E. and Twea, Pakwanja D. and Phillips, Andrew N. and She, Bingling and Tamuri, Asif U. and Nkhoma, Dominic and Mfutso-Bengo, Joseph and Hallett, Timothy B.},
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month = aug,
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year = {2025},
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note = {Publisher: Public Library of Science},
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keywords = {Analyses using the model},
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pages = {e1004488},
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}
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number = {1},
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urldate = {2025-07-24},
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journal = {The Lancet Global Health},
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publisher = {Elsevier BV},
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author = {Hallett, Timothy B and Mangal, Tara D and Tamuri, Asif U and Arinaminpathy, Nimalan and Cambiano, Valentina and Chalkley, Martin and Collins, Joseph H and Cooper, Jonathan and Gillman, Matthew S and Giordano, Mosè and Graham, Matthew M and Graham, William and Hawryluk, Iwona and Janoušková, Eva and Jewell, Britta L and Lin, Ines Li and Manning Smith, Robert and Manthalu, Gerald and Mnjowe, Emmanuel and Mohan, Sakshi and Molaro, Margherita and Ng'ambi, Wingston and Nkhoma, Dominic and Piatek, Stefan and Revill, Paul and Rodger, Alison and Salmanidou, Dimitra and She, Bingling and Smit, Mikaela and Twea, Pakwanja D and Colbourn, Tim and Mfutso-Bengo, Joseph and Phillips, Andrew N},
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month = jan,
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year = {2025},
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note = {Publisher: Elsevier BV},
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keywords = {Overview of the model},
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pages = {e28--e37},
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}
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number = {8},
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urldate = {2025-07-24},
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journal = {The Lancet Global Health},
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publisher = {Elsevier BV},
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author = {Lin, Inês Li and McCollum, Eric D and Buckley, Eric and Collins, Joseph H and Graham, Matthew M and Janoušková, Eva and King, Carina and Lufesi, Norman and Mangal, Tara D and Mfutso-Bengo, Joseph and Mnjowe, Emmanuel and Mohan, Sakshi and Molaro, Margherita and Nkhoma, Dominic and Nsona, Humphreys and Rothkopf, Alexander and She, Bingling and Smith, Lisa and Tamuri, Asif U and Revill, Paul and Cambiano, Valentina and Phillips, Andrew N and Hallett, Timothy B and Colbourn, Tim},
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month = aug,
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year = {2025},
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note = {Publisher: Elsevier BV},
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keywords = {Analyses using the model},
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pages = {e1466--e1475},
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}
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author = {Mangal, Tara Danielle and Molaro, Margherita and Nkhoma, Dominic and Colbourn, Tim and Collins, Joseph H and Janoušková, Eva and Graham, Matthew M and Lin, Ines Li and Mnjowe, Emmanuel and Mwenyenkulu, Tisungane E and Mohan, Sakshi and She, Bingling and Tamuri, Asif U and Twea, Pakwanja D and Winskill, Peter and Phillips, Andrew and Mfutso-Bengo, Joseph and Hallett, Timothy B},
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month = may,
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year = {2025},
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pmid = {40357264},
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pmcid = {PMC12067010},
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keywords = {Analyses using the model},
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pages = {304--315},
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}
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number = {1},
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urldate = {2025-05-09},
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journal = {Nature Communications},
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publisher = {Nature Publishing Group},
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author = {Collins, Joseph H. and Allott, Helen and Ng’ambi, Wingston and Lin, Ines Li and Giordano, Mosè and Graham, Matthew M. and Janoušková, Eva and Kachale, Fannie and Kawaza, Kondwani and Mangal, Tara D. and Mfutso-Bengo, Joseph and Mnjowe, Emmanuel and Mohan, Sakshi and Molaro, Margherita and Nkhoma, Dominic and Revill, Paul and Rodger, Alison and She, Bingling and Tamuri, Asif U. and Tann, Cally J. and Twea, Pakwanja D. and Cambiano, Valentina and Hallett, Timothy B. and Phillips, Andrew N. and Colbourn, Tim},
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month = apr,
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year = {2025},
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note = {Publisher: Nature Publishing Group},
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keywords = {Analyses using the model},
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pages = {3925},
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}
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journal = {Discover Health Systems},
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author = {Rao, Megha and Nkhoma, Dominic and Mohan, Sakshi and Twea, Pakwanja and Chilima, Benson and Mfutso-Bengo, Joseph and Ochalek, Jessica and Hallett, Timothy B. and Phillips, Andrew N. and McGuire, Finn and Woods, Beth and Walker, Simon and Sculpher, Mark and Revill, Paul},
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year = {2024},
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pmid = {39022531},
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pmcid = {PMC11249770},
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keywords = {Theoretical Frameworks},
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pages = {48},
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}
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number = {Complete},
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urldate = {2024-11-07},
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journal = {Social Science \& Medicine},
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publisher = {Elsevier},
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author = {Tafesse, Wiktoria and Chalkley, Martin},
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year = {2021},
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note = {Publisher: Elsevier},
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keywords = {Healthcare provision},
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}
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number = {2},
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urldate = {2024-11-06},
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journal = {PLOS ONE},
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publisher = {Public Library of Science},
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author = {Ng'ambi, Wingston Felix and Collins, Joseph H. and Colbourn, Tim and Mangal, Tara and Phillips, Andrew and Kachale, Fannie and Mfutso-Bengo, Joseph and Revill, Paul and Hallett, Timothy B.},
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month = feb,
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year = {2022},
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note = {Publisher: Public Library of Science},
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keywords = {Healthcare seeking behaviour},
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pages = {e0263650},
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}
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}
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@article{mangal_potential_2021,
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chapter = {Epidemiology},
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title = {Potential impact of intervention strategies on {COVID}-19 transmission in {Malawi}: a mathematical modelling study},
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volume = {11},
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copyright = {© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.},
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number = {7},
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urldate = {2024-11-06},
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journal = {BMJ Open},
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publisher = {British Medical Journal Publishing Group},
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author = {Mangal, Tara and Whittaker, Charlie and Nkhoma, Dominic and Ng'ambi, Wingston and Watson, Oliver and Walker, Patrick and Ghani, Azra and Revill, Paul and Colbourn, Timothy and Phillips, Andrew and Hallett, Timothy and Mfutso-Bengo, Joseph},
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month = jul,
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year = {2021},
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pmid = {34301651},
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note = {Publisher: British Medical Journal Publishing Group
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Section: Epidemiology},
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keywords = {Analyses using the model},
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pages = {e045196},
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}
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number = {1},
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urldate = {2024-11-06},
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journal = {PLOS ONE},
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publisher = {Public Library of Science},
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author = {She, Bingling and Mangal, Tara D. and Adjabeng, Anna Y. and Colbourn, Tim and Collins, Joseph H. and Janoušková, Eva and Lin, Ines Li and Mnjowe, Emmanuel and Mohan, Sakshi and Molaro, Margherita and Phillips, Andrew N. and Revill, Paul and Smith, Robert Manning and Twea, Pakwanja D. and Nkhoma, Dominic and Manthalu, Gerald and Hallett, Timothy B.},
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month = jan,
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year = {2024},
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note = {Publisher: Public Library of Science},
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keywords = {Analyses using the model},
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pages = {e0290823},
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}
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number = {9},
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urldate = {2024-11-06},
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journal = {PLOS Computational Biology},
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publisher = {Public Library of Science},
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author = {Molaro, Margherita and Mohan, Sakshi and She, Bingling and Chalkley, Martin and Colbourn, Tim and Collins, Joseph H. and Connolly, Emilia and Graham, Matthew M. and Janoušková, Eva and Lin, Ines Li and Manthalu, Gerald and Mnjowe, Emmanuel and Nkhoma, Dominic and Twea, Pakwanja D. and Phillips, Andrew N. and Revill, Paul and Tamuri, Asif U. and Mfutso-Bengo, Joseph and Mangal, Tara D. and Hallett, Timothy B.},
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month = sep,
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year = {2024},
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note = {Publisher: Public Library of Science},
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keywords = {Analyses using the model},
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pages = {e1012462},
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}

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