Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?

Hdl Handle:
http://hdl.handle.net/10144/17723
Title:
Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?
Authors:
Rolland, E; Checchi, F; Pinoges, L; Balkan, S; Guthmann, J P; Guerin, P J
Journal:
Tropical Medicine & International Health
Abstract:
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.
Affiliation:
Epicentre, Paris, France.
Publisher:
Wiley-Blackwell
Issue Date:
Apr-2006
URI:
http://hdl.handle.net/10144/17723
DOI:
10.1111/j.1365-3156.2006.01580.x
PubMed ID:
16553923
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorRolland, E-
dc.contributor.authorChecchi, F-
dc.contributor.authorPinoges, L-
dc.contributor.authorBalkan, S-
dc.contributor.authorGuthmann, J P-
dc.contributor.authorGuerin, P J-
dc.date.accessioned2008-02-07T16:30:13Z-
dc.date.available2008-02-07T16:30:13Z-
dc.date.issued2006-04-
dc.identifier.citationOperational response to malaria epidemics: are rapid diagnostic tests cost-effective? 2006, 11 (4):398-408 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid16553923-
dc.identifier.doi10.1111/j.1365-3156.2006.01580.x-
dc.identifier.urihttp://hdl.handle.net/10144/17723-
dc.description.abstractOBJECTIVE: 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.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAdolescenten
dc.subject.meshAmodiaquineen
dc.subject.meshAntimalarialsen
dc.subject.meshArtemisininsen
dc.subject.meshChilden
dc.subject.meshCost-Benefit Analysisen
dc.subject.meshDiagnostic Tests, Routineen
dc.subject.meshDisease Outbreaksen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshEthanolaminesen
dc.subject.meshFemaleen
dc.subject.meshFluorenesen
dc.subject.meshHealth Care Costsen
dc.subject.meshHumansen
dc.subject.meshMalaria, Falciparumen
dc.subject.meshPregnancyen
dc.subject.meshPregnancy Complications, Infectiousen
dc.subject.meshPrevalenceen
dc.subject.meshSensitivity and Specificityen
dc.subject.meshSesquiterpenesen
dc.titleOperational response to malaria epidemics: are rapid diagnostic tests cost-effective?en
dc.contributor.departmentEpicentre, Paris, France.en
dc.identifier.journalTropical Medicine & International Healthen

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