Hansen Kristian Schultz, Lesner Tine Hjernø, Østerdal Lars Peter
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
Malar J. 2016 Nov 4;15(1):534. doi: 10.1186/s12936-016-1582-1.
Malaria continues to be a serious public health problem particularly in Africa. Many people infected with malaria do not access effective treatment due to high price. At the same time many individuals receiving malaria drugs do not suffer from malaria because of the common practice of presumptive diagnosis. A global subsidy on artemisinin-based combination therapy (ACT) has recently been suggested to increase access to the most effective malaria treatment.
Following the recommendation by World Health Organization that parasitological testing should be performed before treatment and ACT prescribed to confirmed cases only, it is investigated in this paper if a subsidy on malaria rapid diagnostic tests (RDTs) should be incorporated. A model is developed consisting of a representative individual with fever suspected to be malaria, seeking care at a specialized drug shop where RDTs, ACT medicines, and cheap, less effective anti-malarials are sold. Assuming that the individual has certain beliefs of the accuracy of the RDT and the probability that the fever is malaria, the model predicts the diagnosis-treatment behaviour of the individual. Subsidies on RDTs and ACT are introduced to incentivize appropriate behaviour: choose an RDT before treatment and purchase ACT only if the test is positive.
Solving the model numerically suggests that a combined subsidy on both RDT and ACT is cost minimizing and improves diagnosis-treatment behaviour of individuals. For certain beliefs, such as low trust in RDT accuracy and strong belief that a fever is malaria, subsidization is not sufficient to incentivize appropriate behaviour.
A combined subsidy on both RDT and ACT rather than a single subsidy is likely required to improve diagnosis-treatment behaviour among individuals seeking care for malaria in the private sector.
疟疾仍然是一个严重的公共卫生问题，尤其是在非洲。由于价格高昂，许多感染疟疾的人无法获得有效的治疗。与此同时，由于普遍采用推定诊断的做法，许多接受疟疾药物治疗的人并未感染疟疾。最近有人建议对青蒿素联合疗法（ACT）提供全球补贴，以增加获得最有效疟疾治疗的机会。
按照世界卫生组织的建议，即应在治疗前进行寄生虫学检测，且仅对确诊病例开具ACT，本文研究是否应纳入对疟疾快速诊断检测（RDT）的补贴。开发了一个模型，该模型由一名疑似患疟疾发烧的代表性个体组成，该个体在一家专门药店寻求治疗，该药店出售RDT、ACT药物以及廉价但效果较差的抗疟药。假设该个体对RDT的准确性以及发烧是由疟疾引起的概率有一定的认知，该模型预测该个体的诊断 - 治疗行为。引入对RDT和ACT的补贴以激励适当行为：在治疗前选择进行RDT检测，且仅在检测呈阳性时购买ACT。
通过数值求解该模型表明，对RDT和ACT同时进行补贴可使成本最小化，并改善个体的诊断 - 治疗行为。对于某些认知情况，例如对RDT准确性的信任度低以及坚信发烧是由疟疾引起的，补贴不足以激励适当行为。
可能需要对RDT和ACT同时进行补贴而非单一补贴，以改善在私营部门寻求疟疾治疗的个体的诊断 - 治疗行为。
