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]