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Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso

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dc.contributor.author Bisoffi, Z.
dc.contributor.author Sirima, S. B.
dc.contributor.author Meheus, F.
dc.contributor.author Lodesani, C.
dc.contributor.author Gobbi, F.
dc.contributor.author Angheben, A.
dc.contributor.author Tinto, H.
dc.contributor.author Neya, B.
dc.contributor.author Van den Ende, K.
dc.contributor.author Romeo, A.
dc.contributor.author Van den Ende, J.
dc.date.accessioned 2011-08-30T08:11:05Z
dc.date.available 2011-08-30T08:11:05Z
dc.date.issued 2011
dc.identifier.issn 1475-2875
dc.identifier.issn ITG-H3A
dc.identifier.doi http://dx.doi.org/10.1186/1475-2875-10-226
dc.identifier.other ITG-H3A
dc.identifier.other ITG-CLA
dc.identifier.other MULTI
dc.identifier.other HEALTH
dc.identifier.other U-EPID
dc.identifier.other CLINIC
dc.identifier.other U-TROPIC
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other URL
dc.identifier.other FTA
dc.identifier.other Abstract
dc.identifier.other UPD37
dc.identifier.uri http://hdl.handle.net/10390/6646
dc.description.abstract BACKGROUND: Malaria rapid diagnostic tests (RDTs) have generally been found reliable and cost-effective. In Burkina Faso, the adherence of prescribers to the negative test result was found to be poor. Moreover, the test accuracy for malaria-attributable fever (MAF) is not the same as for malaria infection. This paper aims at determining the costs and benefits of two competing strategies for the management of MAF: presumptive treatment for all or use of RDTs. METHODS: A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT) recruiting 852 febrile patients during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis. RESULTS AND DISCUSSION: At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525 E for a death averted, the total cost of managing 1,000 febrile children was 1,747 vs. 1,862 E in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the RDT would be the winning strategy for adults in both seasons and for children in the dry season. At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in patients with false positive RDT results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For children the presumptive strategy remains the best choice for a wide range of scenarios. CONCLUSIONS: For RDTs to be preferred, a positive result should not influence the decision to treat a potentially severe NMFI with antibiotics. In the rainy season the presumptive strategy always remains the better choice for children. en
dc.language English en
dc.subject Protozoal diseases en
dc.subject Malaria en
dc.subject Plasmodium falciparum en
dc.subject Vectors en
dc.subject Mosquitoes en
dc.subject Anopheles en
dc.subject Fever en
dc.subject Rapid diagnostic tests en
dc.subject Compliance en
dc.subject Accuracy en
dc.subject Comparison en
dc.subject Management en
dc.subject Presumptive treatment en
dc.subject Cost-benefit en
dc.subject Decision-tree en
dc.subject Negative en
dc.subject Sensitivity en
dc.subject Children en
dc.subject Seasonality en
dc.subject Burkina Faso en
dc.subject Africa, West en
dc.title Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso en
dc.type Article-E en
dc.citation.issue 226 en
dc.citation.jtitle Malaria Journal en
dc.citation.volume 20 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/21816087
dc.identifier.url http://www.malariajournal.com/content/10/1/226
dc.citation.jabbreviation Malar J en


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