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Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.<\/jats:p>","DOI":"10.1098\/rsif.2014.1356","type":"journal-article","created":{"date-parts":[[2015,5,20]],"date-time":"2015-05-20T09:02:31Z","timestamp":1432112551000},"page":"20141356","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis"],"prefix":"10.1098","volume":"12","author":[{"given":"Eili Y.","family":"Klein","sequence":"first","affiliation":[{"name":"Center for Disease Dynamics, Economics and Policy, Washington, DC, USA"},{"name":"Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Zoology, University of Oxford, Oxford, UK"},{"name":"Sanaria Institute for Global Health &amp; Tropical Medicine, Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramanan","family":"Laxminarayan","sequence":"additional","affiliation":[{"name":"Center for Disease Dynamics, Economics and Policy, Washington, DC, USA"},{"name":"Princeton Environmental Institute, Princeton University, Princeton, NJ, USA"},{"name":"Public Health Foundation of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2015,6,6]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Board on global health","author":"Arrow KJ","year":"2004"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.28.4.949"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61732-2"},{"key":"e_1_3_4_5_2","unstructured":"AMFm Independent Evaluation Team. 2012 Independent evaluation of phase 1 of the Affordable Medicines Facility\u2014malaria (AMFm) multi-country independent evaluation report: final report. 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