Table 2.
Outcomes, total cost by arm, and incremental cost-effectiveness ratio of replacing current diagnostic methods by rapid diagnostic tests in two settings in Dangme West District, 2009*
| Outcomes, costs | Microscopy setting | Presumptive diagnosis setting | ||
|---|---|---|---|---|
| RDT arm | Microscopy arm | RDT arm | Presumptive diagnosis arm | |
| Suspected malaria patients, No. (%) | 1,000 (100%) | 1,000 (100%) | 1,000 (100%) | 1,000 (100%) |
| Of which received: | ||||
| Antimalarials, no antibiotics | 508 (51%) | 527 (53%) | 550 (55%) | 696 (70%) |
| Antimalarials and antibiotics | 116 (12%) | 116 (12%) | 150 (15%) | 231 (23%) |
| Antibiotics, no antimalarials | 168 (17%) | 159 (16%) | 158 (16%) | 38 (4%) |
| Other than antimal. and antibiot. | 207 (21%) | 198 (20%) | 141 (14%) | 35 (3%) |
| Correctly treated patients, No. (%)† | 601 (60%) | 569 (57%) | 651 (65%) | 420 (42%) |
| Total cost, GHS (%) | ||||
| Diagnostics | 2,824 (13%) | 2,028 (9%) | 3,919 (16%) | 0 (0%) |
| Drugs | 2,743 (12%) | 3,433 (16%) | 2,891 (12%) | 3,131 (15%) |
| Salaries, supplies, buildings | 9,849 (44%) | 9,743 (44%) | 10,451 (43%) | 10,564 (49%) |
| Total public health sector cost‡ | 15,416 (69%) | 15,204 (69%) | 17,260 (71%) | 13,695 (64%) |
| Out-of-pocket (travel, drugs) | 973 (4%) | 986 (4%) | 901 (4%) | 896 (4%) |
| Opportunity cost (travel, waiting) | 1,619 (7%) | 1,603 (7%) | 1,556 (6%) | 1,572 (7%) |
| Opportunity cost (work time lost) | 4,257 (19%) | 4,303 (19%) | 4,466 (18%) | 5,209 (24%) |
| Total patient cost§ | 6,849 (31%) | 6,892 (31%) | 6,924 (29%) | 7,677 (36%) |
| Total societal cost | 22,265 (100%) | 22,096 (100%) | 24,184 (100%) | 21,373 (100%) |
| Incremental analysis | Replace microscopy diagnosis by RDT diagnosis | Replace presumptive diagnosis by RDT diagnosis | ||
| Increase in no. of corr. treated pts | 32 | 231 | ||
| Incremental cost, health sector, GHS | 212 | 3,565 | ||
| Incremental cost, societal, GHS | 170 | 2,812 | ||
| ICER, health sector, GHS¶ | 6.7 | 15.4 | ||
| ICER, societal, GHS¶ | 5.3 | 12.2 | ||
*
Ghana, normalized to a population of 1,000 patients per arm. (GHS1 = US$0.68).
†
Patients with a parasite positive research slide who were prescribed an antimalarial or patients with a parasite negative research slide who were not prescribed an antimalarial.
‡
Including initial health facility visits (patient recruitment) plus additional health facility visits within two weeks.
§
Including initial health facility visits (patient recruitment) plus additional health facility and chemical seller visits within 2 weeks.
¶
ICER = Incremental Cost-Effectiveness Ratio.