title: 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.
authors.affiliation: Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom. yoel.lubell@lshtm.ac.uk
authors.forename: Yoel
authors.initials: Y
authors.lastname: Lubell
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: Hilda
authors.initials: H
authors.lastname: Mbakilwa
authors.forename: Rose
authors.initials: R
authors.lastname: Mwangi
authors.forename: Kini
authors.initials: K
authors.lastname: Chonya
authors.forename: Christopher J M
authors.initials: CJ
authors.lastname: Whitty
authors.forename: Anne
authors.initials: A
authors.lastname: Mills
mesh_terms: D037621:Artemisinins / Q000627:therapeutic use; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D007783:Lactones / Q000627:therapeutic use; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000469:parasitology; D008853:Microscopy / Q000379:methods; D011934:Reagent Strips / Q000191:economics; D012680:Sensitivity and Specificity; D012717:Sesquiterpenes / Q000627:therapeutic use
chemical_list: D037621:Artemisinins; D007783:Lactones; D011934:Reagent Strips; D012717:Sesquiterpenes; C075875:artemisin