Department of Community Health, Mbarara University of Science & Technology P, O, Box 1410, Mbarara, Uganda.
Malar J. 2011 Dec 19;10:372. doi: 10.1186/1475-2875-10-372.
Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed at rural operational primary care centres.
Three health centres (HCs) were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis) in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients departments were enrolled from March 2010 to February 2011. Of these, a random sample of 1,627 was selected to measure additional socio-economic characteristics. Costing was performed following the standard step-down cost allocation and the ingredients approach. Effectiveness was measured as the number and proportion of patients correctly diagnosed and treated. Incremental Cost-Effectiveness Ratios (ICERs) were estimated from the societal perspective (http://Clinicaltrials.gov, NCT00565071).
Overall RDT was most cost-effective with lowest ICER US$5.0 compared to microscopy US$9.61 per case correctly diagnosed and treated. In the high transmission setting, ICER was US$4.38 for RDT and US$12.98 for microscopy. The corresponding ICERs in the low transmission setting were US$5.85 and US$7.63 respectively. The difference in ICERs between RDT and microscopy was greater in the high transmission area (US$8.9) than in low transmission setting (US$1.78). At a willingness to pay of US$2.8, RDT remained cost effective up to a threshold value of the cost of treatment of US$4.7.
RDT was cost effective in both low and high transmission settings. With a global campaign to reduce the costs of AL and RDT, the Malaria Control Programme and stakeholders need a strategy for malaria diagnosis because as the cost of AL decreases, presumptive treatment is likely to become more attractive.
乌干达国家疟疾治疗指南目前建议在使用青蒿琥酯-咯萘啶（AL）治疗之前，通过显微镜检查或快速诊断检测（RDT）进行寄生虫学确认。然而，这些策略在农村基层医疗中心的成本效益尚未得到评估。
在乌干达疟疾传播强度低和高的两个地区的三个卫生中心（HC）中，将患者随机分配到显微镜检查、RDT 和推定诊断三个诊断组。2010 年 3 月至 2011 年 2 月，从门诊部门就诊的发热患者中招募了 22052 例患者。其中，随机抽取了 1627 例患者以测量额外的社会经济特征。成本核算按照标准逐步成本分配和成分法进行。有效性的衡量标准是正确诊断和治疗的患者数量和比例。从社会角度出发，采用增量成本效益比（ICER）进行估计（http://Clinicaltrials.gov，NCT00565071）。
总体而言，RDT 是最具成本效益的，其每例正确诊断和治疗的增量成本效益比（ICER）最低，为 5.0 美元，而显微镜检查的 ICER 为 9.61 美元。在高传播地区，RDT 的 ICER 为 4.38 美元，显微镜检查的 ICER 为 12.98 美元。在低传播地区，相应的 ICER 分别为 5.85 美元和 7.63 美元。在高传播地区，RDT 和显微镜检查的 ICER 差异较大（8.9 美元），而在低传播地区的差异较小（1.78 美元）。在支付意愿为 2.8 美元的情况下，RDT 在治疗成本达到 4.7 美元的阈值之前仍然具有成本效益。
RDT 在低传播和高传播地区均具有成本效益。随着降低青蒿琥酯和 RDT 成本的全球运动的开展，疟疾控制规划和利益相关者需要制定疟疾诊断策略，因为随着青蒿琥酯价格的降低，推测性治疗可能会变得更具吸引力。
