Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, BP 220-Dakar, Sénégal.
Malar J. 2010 Jun 4;9:153. doi: 10.1186/1475-2875-9-153.
In 2006, the Senegalese National Malaria Control Programme (NMCP) has recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck). Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i) to study the accuracy of Paracheck compared to the thick blood smear (TBS) in two areas with different levels of malaria endemicity and ii) analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP.
A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal) nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT.
A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700 euros per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes of illness. The present study also demonstrated that full compliance of health care providers with RDT results was required in order to avoid severe incremental costs.
A rational use of ACT requires laboratory testing of all patients presenting with presumed malaria. Use of RDTs inevitably has incremental costs, but the strategy associating RDT use for all clinically suspected malaria and prescribing ACT only to patients tested positive is cost-effective in areas where microscopy is unavailable.
2006 年，塞内加尔国家疟疾控制规划（NMCP）推荐青蒿素为基础的联合疗法（ACT）作为治疗无并发症疟疾的一线药物，并于 2007 年要求对所有疑似疟疾患者进行检测，采用基于恶性疟原虫 HRP-2 的快速诊断检测试剂（RDT(Paracheck)）进行疟疾检测。由于 ACT 的成本高于早期抗疟药物，因此本研究的目的是：i）研究在两个疟疾流行程度不同的地区，Paracheck 与厚血涂片（TBS）相比的准确性；ii）分析 NMCP 推荐的疑似疟疾病例寄生虫学确认管理策略的成本效益。
在塞内加尔的 Dielmo 和 Ndiop 村庄进行了一项横断面研究，这些村庄嵌套在一项约 800 名居民的队列研究中。对于 2008 年 10 月至 2009 年 1 月间所有临床诊断为疟疾的患者，填写问卷并采集指血样本进行显微镜检查和 RDT。考虑了五种方案，NMCP 的建议为参考方案，进行了成本估计和成本效益分析。此外，还进行了敏感性分析，假设所有 RDT 阳性患者和 50%的 RDT 阴性患者均使用 ACT 进行治疗。
研究期间共发生 189 例疑似临床疟疾的就诊。灵敏度、特异性、阳性预测值和阴性预测值分别为 100%、98.3%、80.0%和 100%。参考方案的估计成本接近每 1000 例疾病发作 700 欧元，大约是其他方案的两倍。然而，它似乎是具有成本效益的，同时确保了 100%的疟疾发作的诊断和治疗，以及 98.4%的疾病发作的适当管理。本研究还表明，为了避免严重的增量成本，卫生保健提供者必须完全遵守 RDT 结果。
合理使用 ACT 需要对所有疑似疟疾患者进行实验室检测。使用 RDT 不可避免地会增加成本，但在显微镜不可用的地区，将 RDT 用于所有疑似疟疾患者，并仅对检测阳性的患者开具 ACT 处方的策略具有成本效益。
