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Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda.

Abstract Private sector drug shops are an important source of malaria treatment in Africa, yet diagnosis without parasitological testing is common among these providers. Accurate rapid diagnostic tests for malaria (mRDTs) require limited training and present an opportunity to increase access to correct diagnosis. The present study was a cost-effectiveness analysis of the introduction of mRDTs in Ugandan drug shops.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 29244829
OWN - NLM
STAT- In-Process
LR  - 20171215
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 12
DP  - 2017
TI  - Cost-effectiveness analysis of introducing malaria diagnostic testing in drug
      shops: A cluster-randomised trial in Uganda.
PG  - e0189758
LID - 10.1371/journal.pone.0189758 [doi]
AB  - BACKGROUND: Private sector drug shops are an important source of malaria
      treatment in Africa, yet diagnosis without parasitological testing is common
      among these providers. Accurate rapid diagnostic tests for malaria (mRDTs)
      require limited training and present an opportunity to increase access to correct
      diagnosis. The present study was a cost-effectiveness analysis of the
      introduction of mRDTs in Ugandan drug shops. METHODS: Drug shop vendors were
      trained to perform and sell subsidised mRDTs and artemisinin-based combination
      therapies (ACTs) in the intervention arm while vendors offered ACTs following
      presumptive diagnosis of malaria in the control arm. The effect on the proportion
      of customers with fever 'appropriately treated of malaria with ACT' was captured 
      during a randomised trial in drug shops in Mukono District, Uganda. Health sector
      costs included: training of drug shop vendors, community sensitisation,
      supervision and provision of mRDTs and ACTs to drug shops. Household costs of
      treatment-seeking were captured in a representative sample of drug shop
      customers. FINDINGS: The introduction of mRDTs in drug shops was associated with 
      a large improvement of diagnosis and treatment of malaria, resulting in low
      incremental costs for the health sector at US$0.55 per patient appropriately
      treated of malaria. High expenditure on non-ACT drugs by households contributed
      to higher incremental societal costs of US$3.83. Sensitivity analysis showed that
      mRDTs would become less cost-effective compared to presumptive diagnosis with
      increasing malaria prevalence and lower adherence to negative mRDT results.
      CONCLUSION: mRDTs in drug shops improved the targeting of ACTs to malaria
      patients and are likely to be considered cost-effective compared to presumptive
      diagnosis, although the increased costs borne by households when the test result 
      is negative are a concern.
FAU - Hansen, Kristian Schultz
AU  - Hansen KS
AD  - Department of Global Health and Development, London School of Hygiene and
      Tropical Medicine, London, United Kingdom.
AD  - Department of Public Health, Section for Health Services Research, University of 
      Copenhagen, Copenhagen, Denmark.
FAU - Clarke, Sian E
AU  - Clarke SE
AD  - Department of Disease Control, London School of Hygiene and Tropical Medicine,
      London, United Kingdom.
FAU - Lal, Sham
AU  - Lal S
AD  - Department of Disease Control, London School of Hygiene and Tropical Medicine,
      London, United Kingdom.
FAU - Magnussen, Pascal
AU  - Magnussen P
AD  - Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.
FAU - Mbonye, Anthony K
AU  - Mbonye AK
AD  - Directorate of Clinical and Community Services, Ministry of Health, Kampala,
      Uganda.
AD  - School of Public Health, College of Health Sciences, Makerere University,
      Kampala, Uganda.
LA  - eng
PT  - Journal Article
DEP - 20171215
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
EDAT- 2017/12/16 06:00
MHDA- 2017/12/16 06:00
CRDT- 2017/12/16 06:00
PHST- 2016/03/27 00:00 [received]
PHST- 2017/12/02 00:00 [accepted]
PHST- 2017/12/16 06:00 [entrez]
PHST- 2017/12/16 06:00 [pubmed]
PHST- 2017/12/16 06:00 [medline]
AID - 10.1371/journal.pone.0189758 [doi]
AID - PONE-D-16-12472 [pii]
PST - epublish
SO  - PLoS One. 2017 Dec 15;12(12):e0189758. doi: 10.1371/journal.pone.0189758.
      eCollection 2017.