Table 3.
Incremental costs, outcomes and cost-effectiveness of introducing subsidised malaria RDTs for 100 000 febrile patients in three private retail sector treatment scenarios (three small-scale studies in Nigeria (TS-N), Tanzania (TS-T) and Uganda (TS-U)), at 5% and 50% PfPR (2017 US$)
| 5% PfPR | 50% PfPR | |||||
| TS-N | TS-T | TS-U | TS-N | TS-T | TS-U | |
| Incremental health service costs (US$) | ||||||
| RDT | 7462 | 7462 | 7462 | 7462 | 7462 | 7462 |
| Initial treatment | 4700 | −3058 | −1186 | 6070 | −649 | −375 |
| Further care | −71 | −733 | 1537 | −3338 | −2813 | 2464 |
| Supporting intervention | 42 931 | 42 931 | 42 931 | 42 931 | 42 931 | 42 931 |
| Total incremental health service costs | 55 022 | 46 602 | 50 743 | 53 125 | 46 931 | 52 481 |
| Incremental health service costs per febrile patient | 0.55 | 0.47 | 0.51 | 0.53 | 0.47 | 0.52 |
| Incremental patient OOP costs (US$) | ||||||
| RDT | 13 530 | 13 530 | 13 530 | 13 530 | 13 530 | 13 530 |
| Initial treatment | 2740 | −7282 | −5773 | 4648 | −2377 | −3837 |
| Further care | −31 | −228 | 467 | −1770 | −1438 | 1193 |
| Total incremental patient OOP costs | 16 239 | 6020 | 8224 | 16 409 | 9714 | 10 886 |
| Incremental patient OOP costs per febrile patient | 0.16 | 0.06 | 0.08 | 0.16 | 0.10 | 0.11 |
| Total incremental societal costs (US$) | 71 261 | 52 622 | 58 967 | 69 534 | 56 646 | 63 368 |
| Incremental societal costs per febrile patient | 0.71 | 0.53 | 0.59 | 0.70 | 0.57 | 0.63 |
| Incremental intermediate outcomes | ||||||
| Of patients with malaria*, number (% change) that get ACT | 1773 (211%) |
474 (25%) |
123 (8%) |
17 726 (211%) |
4737 (25%) |
1228 (8%) |
| Of patients without malaria†, number (% change) that get ACT | 21 467 (126%) |
−15 698 (−40%) |
−6025 (−20%) |
11 298 (126%) |
−8262 (−40%) |
−3171 (−20%) |
| Of patients with malaria*, number (% change) that get other antimalarial (not ACT) | −1,585 (−57%) |
−127 (−9%) |
−497 (−23%) |
−15 848 (−57%) |
−1266 (−9%) |
−4969 (−23%) |
| Of patients without malaria†, number (% change) that get other antimalarial (not ACT) | −25 457 (−45%) |
−6265 (−21%) |
−14 345 (−34%) |
−13 472 (−45%) |
−3304 (−22%) |
−7879 (−35%) |
| Of patients with malaria*, number (% change) that get any antimalarial | 188 (5%) |
347 (10%) |
−374 (−10%) |
1879 (5%) |
3471 (10%) |
−3741 (−10%) |
| Of patients without malaria†, number (% change) that get any antimalarial | −3990 (−5%) |
−21 963 (−32%) |
−20 370 (−28%) |
−2 174 (−6%) |
−11 566 (−32%) |
−11 051 (−29%) |
| Of patients with bacterial infection, number (% change) that get antibiotic | −483 (−26%) |
−84 (−6%) |
−351 (−10%) |
−287 (−30%) |
−29 (−4%) |
−228 (−12%) |
| Of patients without bacterial infection‡, number (% change) that get antibiotic | −4620 (−27%) |
−788 (−6%) |
−3376 (−10%) |
−5338 (−29%) |
−601 (−4%) |
−4185 (−12%) |
| Incremental final health outcomes—DALYS averted | ||||||
| Plasmodium falciparum malaria | 631 | 488 | −373 | 1276 | 988 | −754 |
| Bacterial | −523 | −93 | −378 | −115 | −19 | −81 |
| Viral | 0 | 0 | 0 | 0 | 0 | 0 |
| Coinfection | 6 | 9 | −12 | 56 | 79 | −107 |
| All febrile illness | 114 | 404 | −763 | 1217 | 1047 | −942 |
| Cost-effectiveness (US$) | ||||||
| Health service costs per DALY averted | 482 | 115 | Dominated | 44 | 45 | Dominated |
| Societal cost per DALY averted | 624 | 130 | Dominated | 57 | 54 | Dominated |
*Patients with malaria: patients with malaria only plus patients with coinfection.
†Patients without malaria: patients with a non-malarial febrile illness (NMFI) (bacterial or viral).
‡Patients without bacterial infection: patients with viral NMFI plus patients with malaria only.
ACT, artemisinin combination therapy; DALY, disability-adjusted life year; OOP, out-of-pocket; PfPR, Plasmodium falciparum positivity rate; RDT, rapid diagnostic test.