Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy
Rapid diagnostic tests (RDTs) are effective and simple devices for diagnosing malaria. As such, they could potentially be of great use to heath workers in a wide range of malarious areas. In this paper, the cost-effectiveness of RDTs in sub-Saharan Africa is evaluated relative to presumptive treatment with artemisinin-based combination therapy for patients presenting to health clinics as febrile outpatients. This analysis will inform a critical issue that is particularly relevant in the advent of a shift to first line treatment with this new class of drugs. Decision tree analysis was used within a net-benefit framework to determine the probability that RDTs are cost-effective across a spectrum of possible prevalence levels. At a ceiling ratio of US$150/DALY averted, it is 95% certain that RDTs are cost-effective below 15% malaria prevalence, and not cost-effective above 70% malaria prevalence. The use of dipstick diagnosis prior to artemisinin-based combination therapy appears cost-effective for use in areas of low to moderate endemicity, or in areas of seasonal transmission when transmission is low.
Shillcutt, S.; Morel, C.; Goodman, C.; Coleman, P.; Bell, D.; Whitty, C.J.M.; Mills, A. Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bulletin of the World Health Organization (2008) 86 (2) 101-110. [DOI: 10.2471/BLT.07.042259]