Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?
OBJECTIVE: To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). METHODS: We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced o...
| Main Authors: | , , , , , |
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| Format: | Journal article |
| Language: | English |
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2006
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| _version_ | 1826307022851670016 |
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| author | Rolland, E Checchi, F Pinoges, L Balkan, S Guthmann, J Guerin, P |
| author_facet | Rolland, E Checchi, F Pinoges, L Balkan, S Guthmann, J Guerin, P |
| author_sort | Rolland, E |
| collection | OXFORD |
| description | OBJECTIVE: To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). METHODS: We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. RESULTS: As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. CONCLUSION: In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow. |
| first_indexed | 2024-03-07T06:56:46Z |
| format | Journal article |
| id | oxford-uuid:fe65be2a-0434-45c0-bc73-cd9b262cf4a9 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T06:56:46Z |
| publishDate | 2006 |
| record_format | dspace |
| spelling | oxford-uuid:fe65be2a-0434-45c0-bc73-cd9b262cf4a92022-03-27T13:36:08ZOperational response to malaria epidemics: are rapid diagnostic tests cost-effective?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:fe65be2a-0434-45c0-bc73-cd9b262cf4a9EnglishSymplectic Elements at Oxford2006Rolland, EChecchi, FPinoges, LBalkan, SGuthmann, JGuerin, P OBJECTIVE: To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). METHODS: We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. RESULTS: As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. CONCLUSION: In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow. |
| spellingShingle | Rolland, E Checchi, F Pinoges, L Balkan, S Guthmann, J Guerin, P Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? |
| title | Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? |
| title_full | Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? |
| title_fullStr | Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? |
| title_full_unstemmed | Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? |
| title_short | Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? |
| title_sort | operational response to malaria epidemics are rapid diagnostic tests cost effective |
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