Abstract
BackgroundIn areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective.MethodThe cost-effectiveness of the Optimal® and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters.ResultsIn the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy.ConclusionMicroscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.
Highlights
In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective
Microscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field
Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field
Summary
In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective. In Brazil, 99.8% of malaria cases occur in the Amazon Region, of which more than 70% are due to Plasmodium vivax [1]. Risk for malaria is given by the malaria annual parasitic incidence (API) which stratifies in high (> 49.9 malaria cases/1,000 population), medium (10 - 49.9 cases/1,000 population) or low (< 10 cases/1,000 population) risk [2,3]. Between 2003 and 2007, the API of the Amazon Region ranged from 18.3 to 26.6 cases/1,000 population. In 2007, 457,659 cases were registered in the region, with an API of 19.2 cases/1,000 population [1]. Reliable and efficient diagnostic methods are essential in endemic countries [4]
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