The Cost-Effectiveness of Parasitologic Diagnosis for Malaria-Suspected Patients in an Era of Combination Therapy

Abstract

The introduction of artemisinin-based combination therapy in sub-Saharan Africa has prompted calls for increased use of parasitologic diagnosis for malaria. We evaluated the cost-effectiveness of rapid diagnostic tests (RDTs) in comparison to microscopy in guiding treatment of non-severe febrile illness at varying levels of malaria endemicity using data on test accuracy and costs collected as part of a Tanzanian trial. If prescribers complied with current guidelines, microscopy would give rise to lower average costs per patient correctly treated than RDTs in areas of both high and low transmission. RDT introduction would result in an additional 2.3% and 9.4% of patients correctly treated, at an incremental cost of $25 and $7 in the low and high transmission settings, respectively. Cost-effectiveness would be worse if prescribers do not comply with test results. The cost of this additional benefit may be higher than many countries can afford without external assistance or lower RDT prices.

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

“…The incremental cost of introducing RDTs with enhanced training for the trial was $3.71 per patient correctly treated from a societal perspective (2011 prices). 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].…”

“…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].…”

“…This assumption has been emphasized in several studies [7,9,10], and the sensitivity of cost-effectiveness results to health workers' practice has been illustrated using trial data from Tanzania [8]. 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].…”

Relación costo-efectividad del uso de pruebas rápidas para el diagnóstico de la malaria en la Amazonia peruana

“…Shillcutt y colaboradores se basaron en un árbol de decisiones y el análisis de sensibilidad probabilístico para confirmar que las pruebas rápidas podían resultar más efectivas en función del costo en la mayoría de los escenarios de África Subsahariana en comparación con el tratamiento presuntivo (37). Por su parte, Lubell y colaboradores, en Uganda, demostraron con un modelo similar que la relación costo-efectividad de las pruebas rápidas varió según la región y que los principales factores que influyeron en estas variaciones fueron la intensidad de la transmisión de la malaria y los costos y el desempeño (sensibilidad y especificidad) de las pruebas rápidas (38).…”

Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings

“…The cost of the assay itself was valued at $0.53 in the base case. 16,23,24 This gave a total cost of $3.58 per case for the sepsis POCT. The cost of antimicrobial treatment was set at $13.22 based on the cost for an antimicrobial emergency dose and standard treatment using ampicillin and gentamicin for 5 days.…”