Cost-effectiveness analysis of malaria rapid diagnostic tests: a systematic review

Ling, Xiaoxiao; Jin, Jiajie; Zhu, Guoding; Wang, Weiming; Cao, Yuanyuan; Mu, Yang; Zhou, Huayun; Cao, Jun; Huang, Jiayan

doi:10.1186/s40249-019-0615-8

Cited by 31 publications

(33 citation statements)

References 42 publications

(127 reference statements)

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“…Furthermore, compared to microscopy or PCR, the diagnostic cost of RDTs is relatively low, with a low cost of RDT strips and the training fees for laboratory staff. A few studies have been undertaken to evaluate the economic value of RDTs and they demonstrated that in comparison with microscopy, RDTs are more cost-effective if the whole treatment course have been taken into account [78][79][80]. Therefore, as most of the malaria-endemic areas have limited resources, RDTs is of high value to be used there.…”

Section: Viewpoints Papersmentioning

confidence: 99%

High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Zhu

Ling

Shang

et al. 2020

Journal of Global Health

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High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis Background Children aged under five years accounted for 61% of all malaria deaths worldwide in 2017, and quicker differential diagnosis of malaria fever is vital for them. Rapid diagnostic tests (RDTs) are strips to detect Plasmodium-specific antigens promptly and are helpful in resource-limited areas. Thus, our aim is to assess the diagnostic accuracy of RDTs for malaria in children against the gold standard. Methods MEDLINE, Web of Science, EMBASE, Cochrane Library, the China National Knowledge Infrastructure, Wanfang, and Sinomed databases were systematically searched on August 23, 2019. Studies that compared RDTs with microscopy or polymerase chain reaction in malaria diagnoses for children were eligible. Relevant data were extracted. The quality of studies was evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies instrument. Meta-analyses were carried out to calculate the pooled estimates and 95% confidence intervals of sensitivity and specificity. Results 51 articles were included. For diagnostic accuracy, the pooled estimates of the sensitivity and specificity of RDTs were 0.93 (95% confidence interval (CI) = 0.90, 0.95) and 0.93 (95% CI = 0.90, 0.96) respectively. Studies were highly heterogeneous, and subgroup analyses showed that the application of RDTs in high malaria transmission areas had higher sensitivity but lower specificity than those in low-to-moderate areas. Conclusions RDTs have high accuracy for malaria diagnosis in children, and this characteristic is more prominent in high transmission areas. As they also have the advantages of rapid-detection, are easy-to-use, and can be cost-effective, it is recommended that the wider usage of RDTs should be promoted, especially in resource-limited areas. Further research is required to assess their performance in WHO SouthEast Asia and Americas Region. Electronic supplementary material: The online version of this article contains supplementary material.

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Section: Viewpoints Papersmentioning

confidence: 99%

High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Zhu

Ling

Shang

et al. 2020

Journal of Global Health

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“…8 There is only one published empirical economic evaluation of RDT introduction in the SSA retail sector, 18 which reports cost-effectiveness in terms of intermediate outcomes (cost per appropriately treated patient) 18 rather than final health outcomes (such as disabilityadjusted life years (DALYs) averted). 19 To our knowledge, this paper is the first to model the cost-effectiveness of subsidised malaria RDT introduction in the SSA private sector. Unlike a single empirical study, a modelling approach enables exploration of costeffectiveness under a range of treatment practices, and varying levels of malaria transmission, as well as assessing sensitivity to the many other model parameters.…”

Section: Introductionmentioning

confidence: 99%

Modelling the cost-effectiveness of introducing subsidised malaria rapid diagnostic tests in the private retail sector in sub-Saharan Africa

2020

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BackgroundOver the last 10 years, there has been a huge shift in malaria diagnosis in public health facilities, due to widespread deployment of rapid diagnostic tests (RDTs), which are accurate, quick and easy to use and inexpensive. There are calls for RDTs to be made available at-scale in the private retail sector where many people with suspected malaria seek care. Retail sector RDT use in sub-Saharan Africa (SSA) is limited to small-scale studies, and robust evidence on value-for-money is not yet available. We modelled the cost-effectiveness of introducing subsidised RDTs and supporting interventions in the SSA retail sector, in a context of a subsidy programme for first-line antimalarials.MethodsWe developed a decision tree following febrile patients through presentation, diagnosis, treatment, disease progression and further care, to final health outcomes. We modelled results for three ‘treatment scenarios’, based on parameters from three small-scale studies in Nigeria (TS-N), Tanzania (TS-T) and Uganda (TS-U), under low and medium/high transmission (5% and 50% Plasmodium falciparum (parasite) positivity rates (PfPR), respectively).ResultsCost-effectiveness varied considerably between treatment scenarios. Cost per disability-adjusted life year averted at 5% PfPR was US$482 (TS-N) and US$115 (TS-T) and at 50% PfPR US$44 (TS-N) and US$45 (TS-T), from a health service perspective. TS-U was dominated in both transmission settings.ConclusionThe cost-effectiveness of subsidised RDTs is strongly influenced by treatment practices, for which further evidence is required from larger-scale operational settings. However, subsidised RDTs could promote increased use of first-line antimalarials in patients with malaria. RDTs may, therefore, be more cost-effective in higher transmission settings, where a greater proportion of patients have malaria and benefit from increased antimalarial use. This is contrary to previous public sector models, where RDTs were most cost-effective in lower transmission settings as they reduced unnecessary antimalarial use in patients without malaria.

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“…In sub-Saharan Africa, RDT has now become the most widelyused method for malaria diagnosis among suspected patients in public healthcare institutions [2]. However, previous economic evaluations of RDT were mainly performed in Africa, there was very little evidence from the elimination setting [10]. Moreover, many factors that impact the result of a cost-effectiveness analysis (CEA), such as incidence rate, the distribution of Plasmodium species, labor cost, and health workers' awareness of malaria, were very different in different areas [11,12].…”

Section: Introductionmentioning

confidence: 99%

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

Ling

Jin

et al. 2020

Infect Dis Poverty

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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. This research aimed to offer evidence for helping decision making on malaria diagnosis strategy. Methods A cost-effectiveness analysis was conducted to compare RDT with microscopy examination for malaria diagnosis, by using a decision tree model. There were three strategies of malaria diagnostic testing evaluated in the model, 1) microscopy, 2) RDT, 3) RDT followed by microscopy. The effect indicator was defined as 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. Data collection was conducted in Jiangsu from September 2018 to January 2019. 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 (United States Dollar [USD] 4.47 million) compared to using microscopy alone (238 cases, USD 3.63 million), and RDT followed by microscopy (221 cases, USD 2.75 million). 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.

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Cost-effectiveness analysis of malaria rapid diagnostic tests: a systematic review

Cited by 31 publications

References 42 publications

High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

High value of rapid diagnostic tests to diagnose malaria within children: A systematic review and meta-analysis

Modelling the cost-effectiveness of introducing subsidised malaria rapid diagnostic tests in the private retail sector in sub-Saharan Africa

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

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