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.
Highlights
Within public health facilities in Africa, malaria is largely diagnosed on clinical grounds alone, and fever cases are routinely treated without laboratory confirmation.[1]
Within the rapid diagnostic tests (RDTs) facilities, patients were significantly less likely than in control facilities to receive results for a laboratory test for malaria (84% versus 95%; P = 0.009, by Fischer’s exact test), a difference that was significant in patients ≥ 5 years of age (86% in RDT facilities versus 98% in control facilities; P = 0.04) but not in children less than five years of age (82% in RDT facilities versus 92% in control facilities; P = 0.13)
The results indicate that in the presence of RDTs, drug cost savings are likely to accrue to patients, and may accrue to the providers, especially for adults
Summary
Within public health facilities in Africa, malaria is largely diagnosed on clinical grounds alone, and fever cases are routinely treated without laboratory confirmation.[1]. In many malaria-endemic areas, intense malaria control activities and rapid urbanization have led to decreasing clinical malaria incidence rates. The modern generation of histidine-rich protein 2 (HRP2) antigen-based rapid diagnostic tests (RDTs) has been shown in trials to have high sensitivity and specificity for the diagnosis of Plasmodium falciparum infection among clinical patients in Africa.[5,6] Several studies have shown that the sensitivity of RDTs can be higher than expert microscopy and far more accurate than routine microscopy.[6,7,8,9]
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