Abstract
Substandard and falsified antimalarials contribute to the global malaria burden by increasing the risk of treatment failures, adverse events, unnecessary health expenditures, and avertable deaths. Yet no study has examined this impact in western francophone Africa to date. In Benin, where malaria remains endemic and is the leading cause of mortality among children under five years of age, there is a lack of robust data to combat the issue effectively and inform policy decisions. We adapted the Substandard and Falsified Antimalarial Research Impact (SAFARI) model to assess the health and economic impact of poor-quality antimalarials in this population. The model simulates population characteristics, malaria infection, care-seeking behavior, disease progression, treatment outcomes, and associated costs of malaria. We estimated approximately 1.8 million cases of malaria in Benin among children under five, which cost $193 million (95% CI, $192-$193 million) in treatment costs and productivity losses annually. Substandard and falsified antimalarials were responsible for 11% (nearly 700) of deaths and nearly $20.8 million in annual costs. Moreover, we found that replacing all antimalarials with quality-assured artemisinin combination therapies (ACTs) could result in $29.6 million in annual cost savings and prevent over 1,000 deaths per year. These results highlight the value of improving access to quality-assured ACTs for malaria treatment in Benin. Policy makers and key stakeholders should use these findings to advocate for increased access to quality-assured antimalarials and inform policies and interventions to improve health care access and quality to reduce the burden of malaria.