title: 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.
authors.affiliation: Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200-TB46, New Orleans, LA 70112-2715, USA. jyukich@tulane.edu
authors.forename: Joshua
authors.initials: J
authors.lastname: Yukich
authors.forename: Valerie
authors.initials: V
authors.lastname: D'Acremont
authors.forename: Judith
authors.initials: J
authors.lastname: Kahama
authors.forename: Ndeniria
authors.initials: N
authors.lastname: Swai
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
mesh_terms: D000953:Antigens, Protozoan / Q000276:immunology*; D000962:Antimalarials / Q000627:therapeutic use; D017046:Cost Savings / Q000191:economics*; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D004359:Drug Therapy, Combination; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000635:transmission; D021261:Parasitic Sensitivity Tests; D010963:Plasmodium falciparum / Q000235:genetics / Q000276:immunology*; D011933:Reagent Kits, Diagnostic / Q000191:economics; D013636:Tanzania / Q000453:epidemiology; D014505:Urban Population
chemical_list: D000953:Antigens, Protozoan; D000962:Antimalarials; D011933:Reagent Kits, Diagnostic