Cost-effectiveness of diagnosing and treating malaria symptomatically versus with rapid diagnostic tests in Saraya, southeastern Senegal

This presentation discusses the results and implications of an internal cost-effectiveness analysis of a district-wide rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACT) treatment protocol in Saraya, southeastern Senegal. The data presented consists of a review of data collected over three years through a monitoring system of RDT and ACT use in 6 health posts and 1 health center in the district of Saraya between January 2007 and December 2009. Pharmacy data was used to determine the cost of RDTs (1.20 US$), of treating a child under 13 years (0.58 US$), and of treating an adult (1.22 US$) with ACTs. In the study time period, records were collected for 1,534 patients tested with RDTs, of which 51.6% were positive and were treated with ACTs, and 48.4% were negative. Of the patients with positive RDTs, 64.1% were 13 years or younger, and 35.9% were over 13 years. The cost of screening all patients with RDTs and treating patients with positive results was 261% higher than treating all patients symptomatically ($3,481.92 when RDT screening is used versus $1,334.52 when all symptomatic patients are treated). These results suggest that in areas with a similar age distribution and level of endemicity as Saraya, using RDTs may not be cost effective. This study, however, does not take into account cost externalities of not using RDTs such as the more rapid emergence of resistance, unnecessary numbers of adverse effects, and missed diagnoses.