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

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dc.contributor Epicentre, Paris, France.
dc.creator Rolland, E
dc.creator Checchi, F
dc.creator Pinoges, L
dc.creator Balkan, S
dc.creator Guthmann, J P
dc.creator Guerin, P J
dc.date 2006-04
dc.date.accessioned 2017-01-31T07:09:35Z
dc.date.available 2017-01-31T07:09:35Z
dc.identifier Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? 2006, 11 (4):398-408 Trop. Med. Int. Health
dc.identifier 1360-2276
dc.identifier 16553923
dc.identifier 10.1111/j.1365-3156.2006.01580.x
dc.identifier http://hdl.handle.net/10144/17723
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/17723
dc.identifier Tropical Medicine & International Health
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/17723
dc.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.
dc.language en
dc.publisher Wiley-Blackwell
dc.relation http://www.blackwell-synergy.com/loi/tmi
dc.rights Archived on this site with the kind permission of Wiley-Blackwell
dc.title Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?


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