Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?

摘要: OBJECTIVE To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that rapid diagnostic tests (RDTs). METHODS We calculated direct costs (based experience from Ethiopia and southern Sudan) effectiveness (in terms reduced over-treatment) a free, decentralised programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in Plasmodium falciparum epidemic. Our main measure was incremental cost per false positive averted by RDTs. RESULTS As prevalence increases, difference between RDT-based rises. The threshold above which strategy becomes more expensive is 21% AS AQ scenario 55% ART-LUM scenario, but these thresholds increase to 58 70%, respectively, if financing body tolerates an 1 Euro averted. However, even at high (90%) consistent epidemic peak, would only moderately than strategy: +29.9% +19.4% scenario. comparison insensitive age pregnancy distribution febrile cases, strongly affected variation non-biomedical costs. If their unit price were halved, RDTs be cost-effective up 45% case 68% treatment. CONCLUSION In most scenarios, considerably reduce over-treatment for moderate over diagnosis. A substantial decrease RDT greatly cost-effectiveness, should thus advocated. tolerated probably justified given overall public health financial benefits. considered epidemics logistics human resources allow.