Cost-Effectiveness Analysis of Introducing RDTs for Malaria Diagnosis as Compared to Microscopy and Presumptive Diagnosis in Central and Peripheral Public Health Facilities in Ghana

Abstract

Cost-effectiveness information on where malaria rapid diagnostic tests (RDTs) should be introduced is limited. We developed incremental cost-effectiveness analyses with data from rural health facilities in Ghana with and without microscopy. In the latter, where diagnosis had been presumptive, the introduction of RDTs increased the proportion of patients who were correctly treated in relation to treatment with antimalarials, from 42% to 65% at an incremental societal cost of Ghana cedis (GHS)12.2 (US$8.3) per additional correctly treated patients. In the “microscopy setting” there was no advantage to replacing microscopy by RDT as the cost and proportion of correctly treated patients were similar. Results were sensitive to a decrease in the cost of RDTs, which cost GHS1.72 (US$1.17) per test at the time of the study and to improvements in adherence to negative tests that was just above 50% for both RDTs and microscopy.

Economic Evaluation of a Cluster Randomized Trial of Interventions to Improve Health Workers’ Practice in Diagnosing and Treating Uncomplicated Malaria in Cameroon

“…Similar ICERs have been reported elsewhere [7,10,11,13,29]. For instance, the incremental cost per patient correctly treated by replacing microscopy with RDTs in public health facilities was $3.6 in Ghana (2009 prices) [13], $1.78 in low malaria transmission areas in Uganda, and $8.9 in high malaria transmission areas in Uganda (2011 prices) [11]. Differences in study design should be noted, however, when comparing results, and our study was distinctive for several reasons.…”

“…Results were also sensitive to the prevalence of malaria in febrile patients, specificity and sensitivity of the test, cost of testing and medicines, whether nonmalaria febrile illness was a bacterial or selfresolving viral infection, the efficacy of antimalarials and antibiotics taken, and whether patients take medicines as advised [9]. The literature shows that RDTs tend to be more cost-effective than microscopy when compared with a presumptive diagnosis [7,11,12], while the cost-effectiveness of RDTs compared with microscopy depends on the relative cost of the tests, as well as their specificity and sensitivity in routine use [10,[13][14][15].…”

The Impact of Introducing Malaria Rapid Diagnostic Tests on Fever Case Management: A Synthesis of Ten Studies from the ACT Consortium

“…Analyses of the incremental economic cost per fever case managed have been published for four studies included in this synthesis. Where mRDTs were compared with microscopy (Afgh1, Ghan1, and Cam1), mRDTs were cost saving or costs were similar in Afghanistan, 59 with an incremental provider cost per fever case managed ranging from 0.20 to 1.11 USD in in Ghana 60 and Cameroon 61 (2011 USD). Where mRDTs were compared with clinical diagnosis, the incremental provider cost per fever case managed ranged from 0.24 to 10.9 USD across different transmission levels and provider types in Afghanistan, Ghana, and Uganda (2011 USD).…”

Knowledge and Perception of Malaria Rapid Diagnostic Test among Medical Doctors in a South Eastern Nigeria Tertiary Hospital

“…mRDT has been shown to be effective even in low transmission areas [25]. Some studies in Africa revealed that using mRDT enhanced correct treatment of malaria more than microscopy [26] [27]. It is important that these wrong perceptions among doctors about mRDT be addressed so that doctors effectively play leading roles aimed at using mRDT as an important tool for implementing the WHO malaria Test, Treat and Trackinitiative.…”