cost-effectiveness of treating malaria following three methods of diagnosis: implications for...
DESCRIPTION
Design: Randomized trial, 6 health centers Population: patients were enrolled In intervention arms finger-prick blood was examined pre-treatment Data on costs was collected from March 2010 to Feb trial districts: high & low transmission 3 MethodsTRANSCRIPT
Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in
UgandaVincent Batwala, Mbarara University, UgandaPascal Magnussen, Copenhagen University, DenmarkFred Nuwaha, Makerere University, Uganda
ICIUM2011, Antalya, Turkey. November 16th
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BackgroundUse of high-cost Artemisinin-based Combination
Therapy (ACT) for treatment of malaria stimulated the need for accurate diagnosis in Africa
Presumptive diagnosis leads to drug expenditure on treatment of non-parasitaemic patients
We assessed the cost-effectiveness of treating malaria with ACT based on rapid test [RDT], microscopy & presumptive diagnosis (Clinicaltrials.gov, NCT00565071)
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Design: Randomized trial, 6 health centers
Population: 22052 patients were enrolled
In intervention arms finger-prick blood was examined pre-treatment
Data on costs was collected from March 2010 to Feb. 2011
2 trial districts: high & low transmission 3
Methods
Costing (Step-down + Ingredients approach)Available Resources Activities at the HC
PersonnelMedicinesStationeryTransportBuildingEquipmentUtilities
AdministrationRecordsCleaning
ClinicalDiagnosticsDispensary
Overhead
Support MCH
Counseling
Outreach
OPD
Final services
Patient costs: only direct non-medical & indirect costs 4
Measure of effectiveness• Proportion of patients correctly identified &
treated
The cost-effectiveness model• Comprehensive decision analytical model in
TreeAge, to calculate the Incremental Cost-Effectiveness Ratios (ICER) from societal perspective
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Methods (cont.)
Major cost categories
0
10
20
30
40
50
60
Presumptive RDT Microscopy
PersonnelDrugsDiagnostics
Results
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Cost-effectiveness model report
Strategy Cost ($) Inc. cost Eff. Inc. eff. ACER ICER
Presumptive
4.04 0.643 6.28
RDT 5.22 1.17 0.877 0.234 5.95 5.0Microscopy
5.53 1.48 0.797 0.154 6.94 9.61
Dominance reportThe strategy “microscopy” is dominated by “RDT”
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Sensitivity analysis
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Key lessons• The major determinants of cost-effectiveness results
were: cost of drugs, cost of diagnostics and cost of personnel
• Cost-effectiveness of RDT greatly improves with reduction in costs of personnel & diagnostics
• There was a significant improvement in antimalarial prescription with parasitological-based diagnosis
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Policy implications to improve use of medicines
There is need to reconsider scaling up use of RDT rather than microscopy
Future research agenda More data is needed on comparative operational
feasibility of RDT and microscopy, whether clinicians use results of parasite-based diagnosis in treating patients who test negative
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