Volume 83, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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; = 0.002) and provider drug costs (savings = U.S. $0.43; = 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%; = 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.


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  1. World Health Organization, 2008. World Malaria Report 2008. WHO/HTM/GMP/2008.1. 2008. Geneva, World Health Organization.
  2. Mundy C, Ngwira M, Kadewele G, Bates I, Squire SB, Gilks CF, , 2000. Evaluation of microscope condition in Malawi. Trans R Soc Trop Med Hyg 94: 583584.[Crossref]
  3. Kahama-Maro J, D'Acremont V, Mtasiwa D, Genton B, Lengeler C, , Low quality of routine microscopy for malaria at different health system levels in Dar es Salaam: rapid diagnostic tests should also be implemented in hospitals and urban settings. Abstract book of the 57th Annual Meeting of the American Society of Tropical Medicine and Hygiene, New Orleans, Louisiana, December 7–11, 2008.
  4. D'Acremont V, Lengeler C, Mshinda H, Mtasiwa D, Tanner M, Genton B, , 2009. Time to move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in African children with fever. PLoS Med 6: e252.[Crossref]
  5. Bell D, Peeling RW, , 2006. Evaluation of rapid diagnostic tests: malaria. Nat Rev Microbiol 4 (Suppl): S34S38.[Crossref]
  6. Ochola LB, Vounatsou P, Smith T, Mabaso ML, Newton CR, , 2006. The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. Lancet Infect Dis 6: 582588.[Crossref]
  7. Bell DR, Wilson DW, Martin LB, , 2005. False-positive results of a Plasmodium falciparum histidine-rich protein 2-detecting malaria rapid diagnostic test due to high sensitivity in a community with fluctuating low parasite density. Am J Trop Med Hyg 73: 199203.
  8. Dal-Bianco MP, Köster KB, Kombila UD, Kun JF, Grobusch MP, Ngoma GM, Matsiegui PB, Supan C, Salazar CL, Missinou MA, Issifou S, Lell B, Kremsner P, , 2007. High prevalence of asymptomatic Plasmodium falciparum infection in Gabonese adults. Am J Trop Med Hyg 77: 939942.
  9. Stauffer WM, Cartwright CP, Olson DA, Juni BA, Taylor CM, Bowers SH, Hanson KL, Rosenblatt JE, Boulware DR, , 2009. Diagnostic performance of rapid diagnostic tests versus blood smears for malaria in US clinical practice. Clin Infect Dis 49: 908913.[Crossref]
  10. Mayxay M, Pukrittayakamee S, Chotivanich K, Looareesuwan S, White NJ, , 2001. Persistence of Plasmodium falciparum HRP-2 in successfully treated acute falciparum malaria. Trans R Soc Trop Med Hyg 95: 179182.[Crossref]
  11. Iqbal J, Siddique A, Jameel M, Hira PR, , 2004. Persistent histidine-rich protein 2, parasite lactate dehydrogenase, and panmalarial antigen reactivity after clearance of Plasmodium falciparum monoinfection. J Clin Microbiol 42: 42374241.[Crossref]
  12. Swarthout TD, Counihan H, Senga RK, van den Broek I, , 2007. Paracheck-Pf (R) accuracy and recently treated Plasmodium falciparum infections: is there a risk of over-diagnosis? Malar J 6: 58.[Crossref]
  13. Hume JCC, Barnish G, Mangal T, Armazio L, Streat E, Bates I, , 2008. Household cost of malaria overdiagnosis in rural Mozambique. Malar J 7: 33.[Crossref]
  14. Lubell Y, Revburn H, Mbakilwa H, Mwangi R, Chonya K, Whitty CJ, Mills A, , 2007. The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy. Am J Trop Med Hyg 77: 128132.
  15. Zurovac D, Larson BA, Akhwale W, Snow RW, , 2006. The financial and clinical implications of adult malaria diagnosis using microscopy in Kenya. Trop Med Int Health 11: 11851194.[Crossref]
  16. Lubell Y, Reyburn H, Mbakilwa H, Mwangi R, Chonya S, Whitty CJ, Mills A, , 2008. The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis. BMJ 336: 202205.[Crossref]
  17. Jonkman A, Chibwe RA, Khoromana CO, Liabunya UL, Chaponda ME, Kandiero GE, Molyneux ME, Taylor TE, , 1995. Cost-saving through microscopy-based versus presumptive diagnosis of malaria in adult outpatients in Malawi. Bull World Health Organ 73: 223227.
  18. Zikusooka CM, McIntyre D, Barnes KI, , 2008. Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests? Malar J 7: 176.[Crossref]
  19. Shillcutt S, Morel C, Goodman C, Coleman P, Bell D, Whitty CJ, Mills A, , 2008. Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bull World Health Organ 86: 101110.[Crossref]
  20. Lubell Y, Hopkins H, Whitty C, Staedke S, Mills A, , 2007. Modelling costs and benefits of RDTs for the detection of Plasmodium falciparum in Uganda. Am J Trop Med Hyg 77: 98.
  21. Lubell Y, Hopkins H, Whitty CJ, Staedke SG, Mills A, , 2008. An interactive model for the assessment of the economic costs and benefits of different rapid diagnostic tests for malaria. Malar J 7: 21.[Crossref]
  22. Dongus S, Nyika D, Kannady K, Mtasiwa D, Mshinda H, Gosoniu L, Drescher AW, Fillinger U, Tanner M, Killeen GF, Castro MC, , 2009. Urban agriculture and Anopheles habitats in Dar es Salaam, Tanzania. Geospatial Health 3: 189210.[Crossref]
  23. Geissbuhler Y, Kannady K, Chaki PP, Emidi B, Govella NJ, Mayagaya V, Kiama M, Mtasiwa D, Mshinda H, Lindsay SW, Tanner M, Fillinger U, de Castro MC, Killeen GF, , 2009. Microbial larvicide application by a large-scale, community-based program reduces malaria infection prevalence in urban Dar es Salaam, Tanzania. PLoS One 4: e5107.[Crossref]
  24. D'Acremont V, Kahama-Maro J, Swai N, Mtasiwa D, Genton B, Lengeler C, , 2009. Massive reduction of antimalarial prescriptions during programmatic implementation of Rapid Diagnostic Tests in Dar es Salaam, Tanzania. Abstract. 6th European Congress on Tropical Medicine and International Health, Verona, Italy, September 6–10, 2009.
  25. Management Sciences for Health, 2009. International Drug Price Indicator Guide. Management Sciences for Health. Available at: http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=English. Accessed June 5, 2009.
  26. World Health Organization Regional Office for Africa, 2003. AFRO Essential Medicines Price Indicator. Brazzaville, Congo: World Health Organization Regional Office for Africa.
  27. U.S. Bureau of Economic Analysis. U.S. Implicit Price Deflators for Gross Domestic Product. Available at: http://www.bea.gov. Accessed June 10, 2009.
  28. Barber JA, Thompson SG, , 1998. Analysis and interpretation of cost data in randomized controlled trials: review of published studies. BMJ 317: 11951200.[Crossref]
  29. Nixon RM, Wonderling D, Grieve RD, , 2010. Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared. Health Econ 19: 316333.[Crossref]
  30. Rowe AK, Lama M, Onikpo F, Deming MS, , 2002. Design effects and intraclass correlation coefficients from a health facility cluster survey in Benin. Int J Qual Health Care 14: 521523.[Crossref]
  31. Gelband H, Seiter A, , 2007. A global subsidy for antimalarial drugs. Am J Trop Med Hyg 77 (Suppl 6): 219221.
  32. Chima RI, Goodman CA, Mills A, , 2003. The economic impact of malaria in Africa: a critical review of the evidence. Health Policy 63: 1736.[Crossref]
  33. Ettling MB, Shepard DS, , 1991. Economic cost of malaria in Rwanda. Trop Med Parasitol 42: 214218.
  34. Sauerborn R, Shepard DS, Ettling MB, Brinkmann U, Nougtara A, Diesfeld HJ, , 1991. Estimating the direct and indirect economic cost of malaria in a rural district of Burkina Faso. Trop Med Parasitol 42: 219223.
  35. Gatton ML, Cho Min N, , 2004. Cost to the patient for seeking malaria care in Myanmar. Acta Trop 92: 173177.[Crossref]
  36. Morel CM, Thang ND, Xa NX, Hung LX, Thuan LK, Ky PV, Erhart A, Mills AJ, D'Alessandro U, , 2008. The economic burden of malaria on the household in south-central Vietnam. Malar J 7: 166.[Crossref]
  37. Abeku TA, Hay SI, Ochola S, Langi P, Beard B, de Vlas SJ, Cox J, , 2004. Malaria epidemic early warning and detection in African highlands. Trends Parasitol 20: 400405.[Crossref]
  38. Wongsrichanalai C, Barcus MJ, Munth S, Sutamihardja A, Wernsdorfer W, , 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77 (Suppl 6): 119127.

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  • Received : 19 Oct 2009
  • Accepted : 15 Mar 2010

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