Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal
Language: 
English
Short Title: 
Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria
Abstract: 

BACKGROUND: In 2006, the Senegalese National Malaria Control Programme (NMCP) has recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck). Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i) to study the accuracy of Paracheck compared to the thick blood smear (TBS) in two areas with different levels of malaria endemicity and ii) analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP. METHODS: A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal) nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT. RESULTS: A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700 euros per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes of illness. The present study also demonstrated that full compliance of health care providers with RDT results was required in order to avoid severe incremental costs. CONCLUSIONS: A rational use of ACT requires laboratory testing of all patients presenting with presumed malaria. Use of RDTs inevitably has incremental costs, but the strategy associating RDT use for all clinically suspected malaria and prescribing ACT only to patients tested positive is cost-effective in areas where microscopy is unavailable.

Author(s): 
Ly, Alioune Badara
Tall, Adama
Perry, Robert
Baril, Laurence
Badiane, Abdoulaye
Faye, Joseph
Rogier, Christophe
Touré, Aissatou
Sokhna, Cheikh
Trape, Jean-François
Michel, Rémy
Item Type: 
Journal Article
Publication Title: 
Malaria Journal
Journal Abbreviation: 
Malar. J.
Publication Date: 
2010
Publication Year: 
2010
Pages: 
153
Volume: 
9
ISSN: 
1475-2875
DOI: 
10.1186/1475-2875-9-153
Library Catalog: 
PubMed
Extra: 
PMID: 20525322 PMCID: PMC2887884

Turabian/Chicago Citation

Alioune Badara Ly, Adama Tall, Robert Perry, Laurence Baril, Abdoulaye Badiane, Joseph Faye, Christophe Rogier, Aissatou Touré, Cheikh Sokhna, Jean-François Trape and Rémy Michel. 2010. "Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal." Malaria Journal 9: 153. 10.1186/1475-2875-9-153.

Wikipedia Citation

<ref> {{Cite journal | doi = 10.1186/1475-2875-9-153 | issn = 1475-2875 | volume = 9 | pages = 153 | last = Ly | first = Alioune Badara | coauthors = Tall, Adama, Perry, Robert, Baril, Laurence, Badiane, Abdoulaye, Faye, Joseph, Rogier, Christophe, Touré, Aissatou, Sokhna, Cheikh, Trape, Jean-François, Michel, Rémy | title = Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal | journal = Malaria Journal | date = 2010 | pmid = | pmc = }} </ref>