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The Cost-Effectiveness of Parasitologic Diagnosis for Malaria-Suspected Patients in an Era of Combination Therapy

The introduction of artemisinin-based combination therapy in sub-Saharan Africa has prompted calls for increased use of parasitologic diagnosis for malaria. We evaluated the cost-effectiveness of rapid diagnostic tests (RDTs) in comparison to microscopy in guiding treatment of non-severe febrile illness at varying levels of malaria endemicity using data on test accuracy and costs collected as part of a Tanzanian trial. If prescribers complied with current guidelines, microscopy would give rise to lower average costs per patient correctly treated than RDTs in areas of both high and low transmission. RDT introduction would result in an additional 2.3% and 9.4% of patients correctly treated, at an incremental cost of $25 and $7 in the low and high transmission settings, respectively. Cost-effectiveness would be worse if prescribers do not comply with test results. The cost of this additional benefit may be higher than many countries can afford without external assistance or lower RDT prices.

Received August 21, 2006. Accepted for publication February 23, 2007.

Acknowledgments: The authors thank Catherine Goodman, Chris Drakely, Jack Dowie, John Cairns, and Gesine Meyer-Rath for their advice in designing the study and critical comments on the manuscript. This study was conducted within the Joint Malaria Programme, a collaboration between the National Institute for Medical Research in Tanzania, Kilimanjaro Christian Medical Centre, London School of Hygiene and Tropical Medicine, and the University of Copenhagen. Alan Minja, Kereja Mlay, and Rajabu Malahiyo were key hospital staff in each site. Anna Mtei, Emmanuel Mwakasungula, Lilian Ngowi, Boniface Njau, Yustina Mushi, Happiness Manaso, Mary Urio, and Nico Funga collected the outpatient data. Magdalena Massawe, James Kalabashanga, and Hatibu Athumani read research blood films. Prof Raimos Olomi contributed to the study design. We thank the patients and staff in study sites for their support and participation.

Financial support: The trial was sponsored by the Gates Malaria Programme with funds from the Bill & Melinda Gates Foundation, as part of the Joint Malaria Programme of NE Tanzania.

^* Address correspondence to Yoel Lubell, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: yoel.lubell{at}lshtm.ac.uk

Authors’ addresses: Yoel Lubell, Chris Whitty, and Anne Mills, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, Fax: 44–0–20–7637–5391. Hugh Reyburn, Hilda Mbakilwa, Rose Mwangi, and Kini Chonya, Joint Malaria Programme, PO Box 2228, KCMC, Moshi, Tanzania, Telephone: 02–7275–3714, Fax: 02–7275–3982.

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