Skip Navigation

Economic evaluation of a cluster randomized trial of interventions to improve health workers’ practice in diagnosing and treating uncomplicated Malaria in Cameroon


Value in Health

Category: Publications

Author: Lindsay Mangham-Jefferies, Virginia Wiseman, Olivia A. Achonduh, Thomas L. Drake, Bonnie Cundill, Obinna Onwujekwe, Wilfred Mbacham

Published Date: 06 October 2014



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.


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.


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.


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.


Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice.



Research Aims

Related Projects

< Back