Table 2 Summaries of economic results of included studies
From: Cost-effectiveness analysis of malaria rapid diagnostic tests: a systematic review
Study ID | Study perspective | Time horizon | Effectiveness measures | Incremental costs | Incremental effectiveness | ICERs | Sensitivity analysis | Willingness-to-pay threshold | Price year | Discount rate |
|---|---|---|---|---|---|---|---|---|---|---|
Batwala 2011 [27] | Societal | 12 months | The number and proportion of patients correctly diagnosed and treated | RDT vs presumptive: USD 1.17 | RDT vs presumptive: 0.234 | Incremental cost per patient correctly diagnosed and treated of replacing presumptive diagnosis by RDT was USD5.0; and by microscopy was USD 9.61. In high transmission setting, the ICER was USD 4.38 for RDT and was USD 12.98 for microscopy. In low transmission setting, the ICER was USD 5.85 for RDT and USD 7.63 for microscopy. | Reduction in the cost of AL and RDT, and increase in malaria prevalence were associated with improvement in the cost-effectiveness of RDT. | USD 2.8 | USD 2011 | 3% |
RDT vs microscopy: USD - 0.31 | RDT vs microscopy: 0.08 | |||||||||
Gitonga 2012 [28] | NR | NR | The percentage of districts in a given prevalence that were correctly classified | NR | NR | The incremental analysis was not performed | NR | NR | USD 2008–2010 | 3% |
Hansen 2015 [29] | Societal | 12 months | Appropriate treatment of suspected malaria | RDT vs presumptive (low transmission): USD 2.4 | RDT vs presumptive (low transmission): 53.4% | Incremental cost per appropriately treated patient of replacing presumptive diagnosis by RDT was USD 4.5 from a societal perspective. | Probabilistic sensitivity analysis: RDT vs presumptive - Improved effects compared but uncertainty in the incremental costs. RDT vs microscopy - In moderate transmission setting, improved effects in RDT but uncertainty in the incremental costs; In low transmission setting, lower costs in RDT but uncertainty in the effects. Scenario analysis: RDT remained cost-effective compared to microscopy if chloroquine was replaced by ACT or the price of ACT increased. | NR | USD 2009 | 3% |
RDT vs microscopy (moderate transmission): USD - 0.3 RDT vs microscopy (low transmission): USD - 7.1 | RDT vs microscopy (moderate transmission): 7.4% RDT vs microscopy (low transmission): 4% | Incremental cost per appropriately treated patient of replacing microscopy by RDT from a societal perspective was USD - 4.1 (dominant) in moderate transmission setting and USD - 177.5 (dominant) in low transmission setting. | ||||||||
Health sector | RDT vs presumptive (low transmission): USD 1.3 | RDT vs presumptive (low transmission): 53.4% | Incremental cost per appropriately treated patient of replacing presumptive diagnosis by RDT was USD 2.5 from a health sector perspective. | |||||||
RDT vs microscopy (moderate transmission): USD - 0.0 RDT vs microscopy (low transmission): USD - 7.1 | RDT vs microscopy (moderate transmission): 7.4% RDT vs microscopy (low transmission): 4% | Incremental cost per appropriately treated patient of replacing microscopy by RDT from a health sector perspective was USD - 0.0 (dominant) in moderate transmission setting and USD - 177.5 (dominant) in low transmission setting. | ||||||||
Hansen 2017a [30] | Societal | 12 months | Appropriate treatment of malaria with ACT or rectal artesunate | RDT vs presumptive: USD 1658 | RDT vs presumptive: 433 | Incremental cost per additional patient appropriately treated of malaria for RDT compared to presumptive diagnosis was USD 3.83 from a societal perspective | Univariate sensitivity analysis: ICER was sensitive to malaria prevalence levels, RDT price, the specificity of RDT, higher popularity of drug shops offering RDT, adherence to RDT results and ACT prices. Probabilistic sensitivity analysis: Improved effects of RDT. Increased costs of RDT from a health sector perspective and uncertainty in incremental costs from a societal perspective | NR | USD 2011 | 3% |
Health sector | RDT vs presumptive: USD 239 | Incremental cost per ` patient appropriately treated of malaria was USD 0.55 from a health sector perspective | ||||||||
Hansen 2017b [31] | Societal | 12 months | Appropriate treatment of malaria with ACT | RDT vs presumptive (moderate to high transmission): USD 1755 | RDT vs presumptive (moderate to high transmission): 485 | In moderate-to-high transmission setting, incremental cost per additional appropriately treated child under five from a societal perspective was USD 3.6. | Univariate sensitivity analysis: ICER was sensitive to malaria prevalence levels, RDT price, adherence to RDT results and the number of children visiting community health workers. Probabilistic sensitivity analysis: Improved effects of RDT but also increased costs | NR | USD 2011 | 3% |
RDT vs presumptive (low transmission): USD 12283 | RDT vs presumptive (low transmission): 822 | In low transmission setting, incremental cost per additional appropriately treated child under five from a societal perspective was USD 14.9. | ||||||||
Health sector | RDT vs presumptive (moderate to high transmission): USD 1462 | RDT vs presumptive (moderate to high transmission): 485 | In moderate-to-high transmission setting, incremental cost per additional appropriately treated child under five from a health sector perspective was USD 3.0. | |||||||
RDT vs presumptive (low transmission): USD 10924 | RDT vs presumptive (low transmission): 822 | In low transmission setting, incremental cost per additional appropriately treated child under five from a health sector perspective was USD 13.3. | ||||||||
Lemma 2011 [32] | Provider | NR | The number of correctly treated cases | RDT (Parascreen) vs presumptive: USD - 1388.44 | RDT (Parascreen) vs presumptive: 1690 | Incremental cost on Parascreen-BS over presumptive was USD - 0.82 | Result robust: presumptive diagnosis was always dominated. | NR | USD 2007 | NR |
RDT (Paracheck) vs presumptive: USD - 2312.71 | RDT (Paracheck) vs presumptive: 127 | Incremental cost on Paracheck-BS over presumptive was USD - 18.21 | ||||||||
Lubell 2007 [33] | Provider | NR | The proportion of patients correctly treated | RDT vs microscopy (high transmission): USD 0.6 | RDT vs microscopy (high transmission): 9.4% | In high transmission setting, incremental cost per additional patient correctly treated was USD 7.0 | ICER was sensitive to malaria prevalence and the price of RDT. Result was robust to the cost of ACT. | NR | USD 2005 | NR |
RDT vs microscopy (low transmission): USD 0.6 | RDT vs microscopy (low transmission): 2.3% | In low transmission setting, incremental cost per additional patient correctly treated was USD 25.2 | ||||||||
Ly 2010 [34] | SNMCP | NR | The proportion of patients would have been correctly managed | Treatment of all RDT positive patients vs presumptive treatment of all the febrile patients based on their body temperature: $ 460.16 (€ 336.3) per 1000 episodes | Treatment of all RDT positive patients vs presumptive treatment of all the febrile patients based on their body temperature: 48.1% | Incremental cost per additional episode of illness correctly managed of treatment of all RDT positive patients compared to presumptive treatment of all the febrile patients based on their body temperature was $ 0.96 (€ 0.699) | The cost would increase around 50% with full adherence to the test results. | NR | EUR 2008–2009 | NR |
Treatment of all RDT positive patients vs presumptive treatment of suspected patients based on health care provider’s feeling: $ 448.12 (€ 327.5) per 1000 episodes | Treatment of all RDT positive patients vs presumptive treatment of suspected patients based on health care provider’s feeling: 46.6% | Incremental cost per additional episode of illness correctly managed of treatment of all RDT positive patients compared to presumptive treatment of suspected patients based on health care provider’s feeling was $ 0.96 (€ 0.703) | ||||||||
Treatment of all RDT positive patients vs treatment of all febrile RDT positive patients: $ 484.10 (€ 353.8) per 1000 episodes | Treatment of all RDT positive patients vs treatment of all febrile RDT positive patients: 2.6% | Incremental cost per additional episode of illness correctly managed of treatment of all RDT positive patients compared to treatment of all febrile RDT positive patients was $ 18.62 (€ 13.608) | ||||||||
Treatment of all RDT positive patients vs treatment of all children under 6 and all RDT positive patients above 6: $ 119.73 (€ 87.5) per 1000 episodes | Treatment of all RDT positive patients vs treatment of all children under 6 and all RDT positive patients above 6: 40.2% | Incremental cost per additional episode of illness correctly managed of treatment of all RDT positive patients compared to treatment of all children under 6 and all RDT positive patients above 6 was $ 0.30 (€ 0.218) | ||||||||
Matangila 2014 [35] | Provider | 1 month | The number of cases correctly diagnosed | RDT vs microscopy: USD - 1.46 | RDT vs microscopy: 2.3% | Incremental cost per additional case correctly diagnosed for RDT compared to microscopy was USD - 63.47. | Sensitivity analysis for the incremental analysis was not performed. | NR | USD 2012 | NR |
Oliveira 2010 [36] | Public health system | 12 months | The number of adequate diagnosis of suspected malaria | RDT vs microscopy: USD -1.65 | RDT vs microscopy: - 0.3% | Incremental cost per additional case correctly diagnosed for RDT compared to microscopy was USD 549.92 | ICER was sensitive to the sensitivity and specificity of microscopy, the specificity of RDT, the cost of RDT, the cost of transportation to perform one rapid test and thick smear. | NR | USD 2006 | 5% |
Oliveira 2012 [37] | Public health system | 12 months | Adequately diagnosed cases of malaria | RDT (First Response malaria combo) vs exclusive-use microscopy: USD - 24.37 | RDT (First Response malaria combo) vs exclusive-use microscopy: - 0.0685 | Incremental cost per additional adequately diagnosed by First Response Malaria Combo compared to exclusive-use microscopy was USD 355.77 | ICERs of ICT BinaxNOW and CareStart in relation to both exlusive- and shared-use microscopy were robust to the cost of RDT. The cost-effectiveness of SD Bioline was sensitive to the malaria prevalence when RDTs were compared with exclusive-use microscopy. The cost-effectiveness of shared-use microscopy was sensitive to the sensitivity to P.vivax of microscopy and RDT. | NR | USD 2010 | NR |
RDT (Parascreen) vs exclusive-use microscopy: USD - 24.27 | RDT (Parascreen) vs exclusive-use microscopy: - 0.1141 | Incremental cost per additional adequately diagnosed by Parascreen compared to exclusive-use microscopy was USD 212.71 | ||||||||
RDT (SD Bioline FK60) vs exclusive-use microscopy: USD - 24.26 | RDT (SD Bioline FK60) vs exclusive-use microscopy: - 0.0767 | Incremental cost per additional adequately diagnosed by SD Bioline FK60 compared to exclusive-use microscopy was USD 316.30 | ||||||||
RDT (CareStart) vs exclusive-use microscopy: USD - 21.33 | RDT (CareStart) vs exclusive-use microscopy: - 0.0006 | Incremental cost per additional adequately diagnosed by CareStart compared to exclusive-use microscopy was USD 35550 | ||||||||
RDT (ICT BinaxNOW) vs exclusive-use microscopy: USD - 20.26 | RDT (ICT BinaxNOW) vs exclusive-use microscopy: - 0.0369 | Incremental cost per additional adequately diagnosed by ICT BinaxNOW compared to exclusive-use microscopy was USD 549.05 | ||||||||
RDT (First Response malaria combo) vs shared-use microscopy: USD - 0.55 | RDT (First Response malaria combo) vs shared-use microscopy: - 0.0685 | Incremental cost per additional adequately diagnosed by First Response Malaria Combo compared to shared-use microscopy was USD 8.03 | ||||||||
RDT (Parascreen) vs shared-use microscopy: USD - 0.45 | RDT (Parascreen) vs shared-use microscopy: - 0.1141 | Incremental cost per additional adequately diagnosed by Parascreen compared to shared-use microscopy was USD 3.94 | ||||||||
RDT (SD Bioline FK60) vs shared-use microscopy: USD - 0.44 | RDT (SD Bioline FK60) vs shared-use microscopy: - 0.0767 | Incremental cost per additional adequately diagnosed by SD Bioline FK60 compared to shared-use microscopy was USD 5.74 | ||||||||
RDT (CareStart) vs shared-use microscopy: USD 2.49 | RDT (CareStart) vs shared-use microscopy: - 0.0006 | Incremental cost per additional adequately diagnosed by CareStart compared to shared-use microscopy was USD - 4150 | ||||||||
RDT (ICT BinaxNOW) vs shared-use microscopy: USD 3.56 | RDT (ICT BinaxNOW) vs shared-use microscopy: - 0.0369 | Incremental cost per additional adequately diagnosed by ICT BinaxNOW compared to shared-use microscopy was USD - 96.48 | ||||||||
Osei-Kwakye 2013 [38] | Patient | 12 months | The number of cases correctly diagnosed | RDT vs presumptive: USD 1.00 | NR | The incremental analysis was not performed. | Sensitivity analysis for the incremental analysis was not performed. |  | NR | NR |
RDT vs microscopy: USD - 1.50 | NR | |||||||||
Shillcutt 2008 [39] | Provider and patient | NR | DALYs averted | NR | NR | NR | RDT was constantly more cost-effective compared to microscopy and the cost-effectiveness of RDT compared to presumptive diagnosis was sensitive to malaria prevalence, ACT cost, adherence to antibiotics, whether the illness was bacterial, whether a patient diagnosed as not having malaria received antibiotics and policy-maker’s willingness to pay. | USD 150 | USD 2002 | NR |
Tawiah 2016 [40] | Societal | 2 years | The number of appropriately treated children | RDT vs presumptive: USD 1474 per 1000 fever episodes | RDT vs presumptive: 134 per 1000 fever episodes | Incremental cost of introducing RDT to replace presumptive diagnosis per additional appropriately treated child under five from a societal perspective was USD 11.0 | Univariate sensitivity analysis: ICERs from health sector and societal perspective were sensitive to adherence to RDT results, malaria prevalence, RDT specificity. Bivariate sensitivity analysis: ICER was insensitive to the accuracy of RDT. Probabilistic sensitivity analysis: Always improved effects but an increase in costs from a health sector perspective and uncertainty in costs from a societal perspective. | NR | USD 2011 | 5% |
Health sector | RDT vs presumptive: USD 2492 per 1000 fever episodes | Incremental cost of introducing RDT to replace presumptive diagnosis per additional appropriately treated child under five from a health sector perspective was USD 18.6. | ||||||||
Uzochukwu 2009 [41] | Provider and patient | NR | Deaths averted based on the use of the alternative diagnostic strategies | RDT vs presumptive: USD -27 960 per 100 000 malaria cases | RDT vs presumptive: 127 per 100 000 malaria cases | Incremental cost of introducing RDT to replace presumptive diagnosis per death averted was USD - 221. | ICER was sensitive to malaria prevalence, the proportion of non-malaria febrile episodes that were bacterial, sensitivity of RDT, adherence to ACT, the cost of RCT and the cost of ACT. | NR | USD 2008 | NR |
RDT vs microscopy: USD -56 781 per 100 000 malaria cases | RDT vs microscopy: 11 per 100 000 malaria cases | Incremental cost of introducing RDT to replace microscopy per death averted was USD - 5162. |