Hospitalisation costs for malaria and associated factors: a systematic review and meta-analysis

Abstract Objective To analyse the Direct Medical Costs (DMC) of malaria hospitalisation globally, based on literature published between 2012 and 2025. Methods A systematic review and meta-analysis were conducted (PRISMA; PROSPERO: CRD420251081945). Searches included PubMed, Web of Science, VHL-LILACS, CAPES, and SciELO. Methodological quality was assessed using Drummond’s Checklist. All costs were standardised to 2023 International Dollars (Int$) using Purchasing Power Parity (PPP). A random-effects model was employed, supplemented by sensitivity, subgroup, and multivariate meta-regression analyses with log-transformed mean hospitalisation cost per admission as the dependent variable to explore heterogeneity ( I 2 ; Cochrane’s Q ). Results Seven studies (25,071 admissions) were included. The pooled cost estimate was Int$ 685.22, with extreme heterogeneity ( I 2 = 100%; p < 0.001 ). Subgroup analysis revealed a pattern of cost variation coinciding with income level ( p < 0.001 ): High Income (Int$ 11,456.84), Upper-Middle Income (Int$ 1,226.89), and Low/Lower-Middle Income (Int$ 170.51–121.82). Multivariate meta-regression explained 98.40% of heterogeneity identifying retrospective design, broader age groups, and hospital complexity as variables associated with cost variation in this exploratory model ( p < 0.001 ), though these associations should not be interpreted as stable causal predictors given the small number of included studies. Conclusion Malaria hospitalisation costs vary widely across settings, with economic context and health system complexity identified as variables associated with cost variation in exploratory analyses. Cost estimates must be stratified by income level and PPP-adjusted to accurately inform global health policies, resource allocation, and economic evaluations.