cost-effectiveness of treating malaria following three methods of diagnosis: implications for...

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Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling- up use of Rapid Diagnostic Tests in Uganda Vincent Batwala, Mbarara University, Uganda Pascal Magnussen, Copenhagen University, Denmark Fred Nuwaha, Makerere University, Uganda ICIUM2011, Antalya, Turkey. November 16 th 1

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 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 Methods

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Page 1: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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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Page 2: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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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Page 3: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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

Page 4: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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

Page 5: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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.)

Page 6: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

Major cost categories

0

10

20

30

40

50

60

Presumptive RDT Microscopy

PersonnelDrugsDiagnostics

Results

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Page 7: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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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Page 8: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

Sensitivity analysis

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Page 9: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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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Page 10: Cost-effectiveness of treating malaria following three methods of diagnosis: implications for scaling-up use of Rapid Diagnostic Tests in Uganda Vincent

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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