Cost Savings with Rapid Diagnostic Tests for Malaria in Low-Transmission Areas: Evidence from Dar es Salaam, Tanzania

Abstract

Rapid diagnostic tests (RDTs) for malaria may help rationalize antimalarial drug use. However, the economic effects of these tests may vary. Data on costs were collected from 259 patients in 6 health facilities by using exit and in-charge interviews and record reviews during a trial of RDT rollout in Dar es Salaam, Tanzania. The RDTs decreased patient expenditure on drugs (savings = U.S. $0.36; P = 0.002) and provider drug costs (savings = U.S. $0.43; P = 0.034) compared with control facilities. However, RDT introduction did not significantly reduce patients' overall expenditures (U.S. $1.02, 95% confidence interval [CI] = $0.76–$1.36 versus U.S. $1.33 95% CI = $0.99–$1.77) and may increase total provider costs (U.S. $3.63, 95% CI = $3.40–$3.89 versus U.S. $2.32, 95% CI = $1.99–$2.69) compared with control facilities. Clinician's compliance with test results was higher with RDTs than with routine microscopy (95% versus 82%; P = 0.002). The RDTs reduced drug costs in this setting but did not offset the cost of the tests, although they also resulted in non-monetary benefits, including improved management of patients and increased compliance with test results.

Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda

“…In the current paper, the use of RDT increased the cost of diagnosis by US$ 0.67 (about 108% increase) in comparison with the presumptive technique. An increase in provider cost with introduction of RDTs as a diagnostic service was also reported in Tanzania [2,13]. This increase is however likely to be offset by its superior effectiveness if clinicians adhere to test results.…”

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

“…Other modelling and field experience also suggests that overall cost implicaitons will be relatively neutral [14], [31], Through partial recoupment of antibiotic costs from the consumer, the Senegal programme will have limited the impact on less-well funded areas of the health system that fund antibiotic prescription. However, funds saved on ACT conservation could also be spent in future on support for non-malarial fever management if more flexibility was allowed by external agencies in the use of allocated funds.…”

Prevalence of Malaria among Patients Attending Public Health Facilities in Maputo City, Mozambique

“…In low-prevalence settings, efforts should be made to follow the World Health Organization (WHO) recommendations for consistently confirming malaria infection with laboratory tests, either RDTs or microscopy, with subsequent timely provision of appropriate treatment to positive patients. 8,9 In such areas, it may seem inappropriate to rely on presumptive treatment of malaria, as many of the febrile patients will indeed not have malaria and other causes should be investigated and treated. 10 In areas with high prevalence of malaria infection and higher transmission burden, in addition to proper case management of febrile patients, efforts toward malaria prevention, as that provided by an integrated vector control management, should be encouraged…”