About 5% of deaths worldwide are due to malaria, and 5% of the total disease burden among children is due to malaria. The burden is much greater in sub-Saharan Africa, with 15% of all disability-adjusted life-years (DALY) lost to malaria. Malaria is costly, too: an estimated U.S. $1800 million is spent annually on both direct costs of prevention and care, and on indirect costs such as lost productivity, time costs and other indirect costs and losses. There are several economic issues to be addressed with regard to malaria. For example, is malaria control important in comparison with other claims on scarce health resource? Secondly, which approach or strategy for prevention and treatment is most appropriate, given the local circumstances? Thirdly, within each strategy chosen (e.g. diagnosis and treatment of cases), which options are available and which is the best? Within the choice of strategy and design, other issues arise, such as the best options for prevention, and their cost. What strategy is best for case finding? How much should be spent on diagnostics? Under which circumstances does mass treatment make economic sense? When should a new, more expensive drug be used in cases of resistance? Perhaps most importantly, the overall approach needs to be reviewed to ensure that resources are being used to best effect. The role of economics in decision making is the subject of the present review.