Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia

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dc.contributor.authorChanda, Pascalinaen_ZA
dc.contributor.authorCastillo-Riquelme, Marianelaen_ZA
dc.contributor.authorMasiye, Felixen_ZA
dc.date.accessioned2015-10-30T09:28:34Z
dc.date.available2015-10-30T09:28:34Z
dc.date.issued2009en_ZA
dc.description.abstractBACKGROUND:Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT), a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. METHODS: A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT) was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. RESULTS: Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5) than either microscopy (US$ 11.9) or clinical diagnosis (US$ 17.1) for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. CONCLUSION: RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.en_ZA
dc.identifier.apacitationChanda, P., Castillo-Riquelme, M., & Masiye, F. (2009). Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia. <i>Cost Effectiveness and Resource Allocation</i>, http://hdl.handle.net/11427/14503en_ZA
dc.identifier.chicagocitationChanda, Pascalina, Marianela Castillo-Riquelme, and Felix Masiye "Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia." <i>Cost Effectiveness and Resource Allocation</i> (2009) http://hdl.handle.net/11427/14503en_ZA
dc.identifier.citationChanda, P., Castillo-Riquelme, M., & Masiye, F. (2009). Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia. Cost Effectiveness and Resource Allocation, 7(1), 5.en_ZA
dc.identifier.ris TY - Journal Article AU - Chanda, Pascalina AU - Castillo-Riquelme, Marianela AU - Masiye, Felix AB - BACKGROUND:Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT), a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. METHODS: A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT) was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. RESULTS: Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5) than either microscopy (US$ 11.9) or clinical diagnosis (US$ 17.1) for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. CONCLUSION: RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy. DA - 2009 DB - OpenUCT DO - 10.1186/1478-7547-7-5 DP - University of Cape Town J1 - Cost Effectiveness and Resource Allocation LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia TI - Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia UR - http://hdl.handle.net/11427/14503 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14503
dc.identifier.urihttp://dx.doi.org/10.1186/1478-7547-7-5
dc.identifier.vancouvercitationChanda P, Castillo-Riquelme M, Masiye F. Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia. Cost Effectiveness and Resource Allocation. 2009; http://hdl.handle.net/11427/14503.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2009 Chanda et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceCost Effectiveness and Resource Allocationen_ZA
dc.source.urihttp://resource-allocation.biomedcentral.com/en_ZA
dc.subject.otherHealth Economicsen_ZA
dc.subject.otherMalariaen_ZA
dc.subject.otherZambiaen_ZA
dc.titleCost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambiaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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