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Cost Savings with Rapid Diagnostic Tests for Malaria in Low-Transmission Areas: Evidence from Dar es Salaam, Tanzania
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.
Author Notes
Financial support: This study was supported by the Swiss National Science Foundation (grant 3270B0-109696), the Swiss Tropical Institute, the Bill and Melinda Gates Foundation, and the Dar Es Salaam City Medical Office of Health.
Disclosure: The main sponsoring institution (Swiss National Science Foundation) had no role in the study design, data collection, data analysis, data interpretation or writing of this report. All authors had full access to all study data.
Authors' addresses: Joshua Yukich, Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, E-mail: jyukich@tulane.edu. Valerie D'Acremont and Christian Lengeler, Department of Epidemiology and Public Health and Swiss Tropical and Public Health Institute, Basel, Switzerland, E-mails: valerie.dacremont@unibas.ch and christian.lengeler@unibas.ch. Judith Kahama, City Medical Office of Health, Dar Es Salaam City Council, Dar Es Salaam, Tanzania, and Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland, E-mail: judith.kahama@unibas.ch. Ndeniria Swai, City Medical Office of Health, Dar es Salaam City Council, Dar es Salaam, Tanzania, E-mail: ndeswai@yahoo.com.