Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

Abstract

Background As more and more countries approaching the goal of malaria elimination, malaria rapid diagnostic tests (RDT) was recomendated to be a diagnostic strategy to achieve and maintain the statute of malaria free, as it’s less requirments on equipment and experitise than microscopic examination. But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination. Methods A cost-effectiveness analysis, based on data from Jiangsu province, China, was conducted to compare RDT with microscopy examination for malaria diagnosis. There were three strategies of malaria diagnostic testing evaluated using a decision tree model, 1) microscopy, 2) RDT, 3) RDT followed by microscopy. The effects were measured by the number of malaria cases treated appropriately. Based on the joint perspective of health sector and patient, costs data were collected from hospital information systems, key informant interviews, and patient surveys. Epidemiological data were obtained from local malaria surveillance reports. A hypothetical cohort of 300,000 febrile patients were simulated to calculate the total cost and effect of each strategy. One-way, two-way, and probabilistic sensitivity analysis were performed to test the robustness of the result. Results The results showed that RDT strategy was the most effective (245 cases) but also the most costly (4.47 million USD) compared to using microscopy alone (238 cases, 3.63 million USD), and RDT followed by microscopy (221 cases, 2.75 million USD). There was no strategy dominated. One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria. The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability. Conclusions Compared to microscopy and RDT followed by microscopy, RDT strategy had higher effects and higher cost in the setting of malaria elimination. This conclusion still would be held when the change in the proportion of falciparum and the cost fluctuations were accounted.