title: Economic evaluation of a cluster randomized trial of interventions to improve health workers' practice in diagnosing and treating uncomplicated malaria in Cameroon.
abstract: BACKGROUND
  Malaria rapid diagnostic tests (RDTs) are a valid alternative to malaria testing with microscopy and are recommended for the testing of febrile patients before prescribing an antimalarial. There is a need for interventions to support the uptake of RDTs by health workers.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of introducing RDTs with basic or enhanced training in health facilities in which microscopy was available, compared with current practice.
  
  
  METHODS
  A three-arm cluster randomized trial was conducted in 46 facilities in central and northwest Cameroon. Basic training had a practical session on RDTs and lectures on malaria treatment guidelines. Enhanced training included small-group activities designed to change health workers' practice and reduce the consumption of antimalarials among test-negative patients. The primary outcome was the proportion of febrile patients correctly treated: febrile patients should be tested for malaria, artemisinin combination therapy should be prescribed for confirmed cases, and no antimalarial should be prescribed for patients who are test-negative. Individual patient data were obtained from facility records and an exit survey. Costs were estimated from a societal perspective using project reports and patient exit data. The analysis used bivariate multilevel modeling and adjusted for imbalance in baseline covariates.
  
  
  RESULTS
  Incremental cost per febrile patient correctly treated was $8.40 for the basic arm and $3.71 for the enhanced arm. On scale-up, it was estimated that RDTs with enhanced training would save $0.75 per additional febrile patient correctly treated.
  
  
  CONCLUSIONS
  Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: lindsay.mangham-jefferies@lshtm.ac.uk.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Mangham-Jefferies
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
authors.affiliation: Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, The Biotechnology Center, Yaoundé, Cameroon.
authors.forename: Olivia A
authors.initials: OA
authors.lastname: Achonduh
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Oxford, UK; Faculty of Tropical Medicine, Mahidol University, Rajwithi Road, Bangkok, Thailand.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Drake
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cundill
authors.affiliation: Department of Health Administration and Management, College of Medicine, University of Nigeria (Enugu Campus), Enugu, Nigeria.
authors.forename: Obinna
authors.initials: O
authors.lastname: Onwujekwe
authors.affiliation: Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, The Biotechnology Center, Yaoundé, Cameroon.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Mbacham
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D002163:Cameroon; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000209:etiology; D006268:Health Facilities; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007223:Infant; D007318:Inservice Training / Q000458:organization & administration*; D008288:Malaria; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin
keywords: Cameroon; cluster-randomized trial; cost-effectiveness analysis; health worker training; malaria; practice