Mangham-Jefferies L., Wiseman V., Achonduh O.A., Drake T.L., Cundill B., Onwujekwe O., Mbacham W.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, United Kingdom; Laboratory for Public Health Research Biotechnologies, University of Yaoundé i, Biotechnology Center, Yaoundé, Came
Mangham-Jefferies, L., Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, United Kingdom; Wiseman, V., Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, United Kingdom; Achonduh, O.A., Laboratory for Public Health Research Biotechnologies, University of Yaoundé i, Biotechnology Center, Yaoundé, Cameroon; Drake, T.L., Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, United Kingdom, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom, Faculty of Tropical Medicine, Mahidol University, Rajwithi Road, Bangkok, Thailand; Cundill, B., Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Onwujekwe, O., Department of Health Administration and Management, College of Medicine, University of Nigeria (Enugu Campus), Enugu, Nigeria; Mbacham, W., Laboratory for Public Health Research Biotechnologies, University of Yaoundé i, Biotechnology Center, Yaoundé, Cameroon
Background Malaria rapid diagnostic tests (RDTs) are a valid alternative to malaria testing with microscopy and are recommended for the testing of febrile patients before prescribing an antimalarial. There is a need for interventions to support the uptake of RDTs by health workers.Objective To evaluate the cost-effectiveness of introducing RDTs with basic or enhanced training in health facilities in which microscopy was available, compared with current practice.Methods A three-arm cluster randomized trial was conducted in 46 facilities in central and northwest Cameroon. Basic training had a practical session on RDTs and lectures on malaria treatment guidelines. Enhanced training included small-group activities designed to change health workers' practice and reduce the consumption of antimalarials among test-negative patients. The primary outcome was the proportion of febrile patients correctly treated: febrile patients should be tested for malaria, artemisinin combination therapy should be prescribed for confirmed cases, and no antimalarial should be prescribed for patients who are test-negative. Individual patient data were obtained from facility records and an exit survey. Costs were estimated from a societal perspective using project reports and patient exit data. The analysis used bivariate multilevel modeling and adjusted for imbalance in baseline covariates.Results Incremental cost per febrile patient correctly treated was $8.40 for the basic arm and $3.71 for the enhanced arm. On scale-up, it was estimated that RDTs with enhanced training would save $0.75 per additional febrile patient correctly treated.Conclusions Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice. © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).