Cost effectiveness of OptiMal® rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil

Abstract

BackgroundIn areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective.MethodThe cost-effectiveness of the Optimal® and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters.ResultsIn the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy.ConclusionMicroscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.

Malaria Treatment and Prophylaxis in Endemic and Nonendemic Countries: Evidence on Strategies and Their Cost–Effectiveness

“…However, treatment compliance has not been considered in this analysis, and also the costs of time parents took off work when looking after a sick child were not included [1]. A study conducted in the Amazon region in Brazil compared the cost-effectiveness of RDT detecting pLDH (OptiMal ® ) and microscopy, with both P. falciparum and P. vivax present [40]. In this study, all components of malaria diagnosis were included: personnel, equipment, maintenance, training and transportation; however, treatment costs and the societal perspective were excluded.…”

“…When microscopic sensitivity and specificity for P. vivax were 90% and 98%, respectively, and when its sensitivity for P. falciparum was 83%, pLDH RDTs were more cost-effective than microscopy, indicating that very high microscopy accuracy levels are needed for microscopy to be more cost-effective than pLDH RDTs. However, in this study the costs of the antimalarials were not included [40]. Another study conducted in the Amazon region showed that in remote areas HRP-2 RDT was cost-saving compared with microscopy; however, accuracy parameters were not used in this model [41].…”

“…Rolland et al 2006 17 [6] Wiseman et al 2006 17 [38] Chanda et al 2007 18 [10] Lubell et al 2007 17 [14] Lubell et al 2007 13 [34] Lubell et al 2008 14 [35] Shillcutt et al 2008 16 [30] Zikusooka et al 2008 18 [36] Chanda et al 2009 17 [5] Uzochukwu et al 2009 17 [37] Mosha et al 2010 16 [33] de Oliveira et al 2010 16 [40] Ly et al 2010 17 [7] Davis et al 2011 17 [1] Lemma et al 2011 18 [42] Severe malaria…”

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

“…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].…”

Low sensitivity of malaria rapid diagnostic tests stored at room temperature in the Brazilian Amazon Region

“…In Brazil, the National Malaria Control Programme (NMCP) prescribes the use of RDT solely for remote, difficult to access, endemic areas in the Brazilian Amazon [8]. In these locations, the diagnosis of malaria through microscopic analysis is practically impossible because of harsh environmental conditions combined with limited access to electricity and refrigeration, which are necessary for optimal functioning of sensitive equipment.…”