Economic evaluation of a cluster randomized trial of interventions to improve health workers’ practice in diagnosing and treating uncomplicated Malaria in Cameroon
Journal
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
Summary
Background
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.
Objective
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.
Methods
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.
Results
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.
Conclusions
Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice.
