Table 4.

Deterministic sensitivity of incremental health service cost per DALY averted to changes in 16 key model parameters (2017 US$)

Parameter	Best estimate (low-high)	Source for range (if different to PSA range)	5% PfPR						50% PfPR
			TS-N		TS-T		TS-U		TS-N		TS-T		TS-U
			Low	High	Low	High	Low	High	Low	High	Low	High	Low	High
Base case ICER	(Best estimates for each parameter)	(See table 2, online supplementary file S2)	482		115		D		44		45		D
Discount rate	0.03 (0.01–0.10)	Assumptions	290	1372	73	309	D	D	27	120	28	122	D	D
Proportion of patients under 5 years	0.40 (0.30–0.50)	(See table 2)	636	389	128	105	D	D	51	38	53	39	D	D
Patients receiving RDT (‘uptake’)*	0.41 (0.08–0.72)	(See table 2)	1401	316	109	121	D	D	38	49	82	33	D	D
Positive RDT gets antimalarial	(See online supplementary file S4)		D	154	280	72	D	D	76	30	87	30	D	D
Antimalarial with positive RDT result that is ACT			709	362	128	105	D	D	47	41	49	42	D	D
Negative RDT gets antibiotic			D	47	233	31	D	196	45	37	47	37	D	D
Initial treatment parameters for intervention with no test unchanged from control			492		268		868		107		59		210
Reduction in ACT effectiveness due to reduced API consumed	Low transmission: 0.15 (0.00–0.30) Med/high transmission: 0.10 (0.00–0.30)	Assumptions	103	D	90	159	D	D	30	129	39	57	D	D
Reduction in other antimalarial effectiveness due to reduced API consumed			D	131	123	109	D	D	59	31	47	42	D	D
Malaria case progresses to severe with no (or not effective) treatment*	(See PSA ranges in table 2 for <5 and >5 years, low and medium/high transmission settings)		D	40	701	34	D	D	129	5	111	6	D	D
Severe case receives further (inpatient) care*	0.75 (0.19–0.88)	(See table 2)	93	16 013	48	172	D	D	22	58	23	59	D	D
CFR of severe malaria receiving inpatient care *	0.10 (0.05–0.15)		5170	259	144	97	D	D	56	36	56	38	D	D
CFR of severe malaria with no further care *	(See PSA ranges in table 2 for <5 and >5 years, low and medium/high transmission settings)		D	216	236	91	D	D	87	29	81	31	D	D
RDT exmanufacturer price *	0.22 (0.17–0.28)	(See table 2)	471	495	112	119	D	D	43	45	44	46	D	D
ACT exmanufacturer price*	0.68 (0.51–1.56)		472	535	117	106	D	D	42	50	45	44	D	D
Supporting intervention cost per febrile patient	0.43 (0.21–2.54)	Min: −25%; Max: assumption based on18	294	2330	62	638	D	D	26	217	24	247	D	D
	Cost-effective at all six country-specific thresholds (Madagascar, Uganda, Nigeria, Tanzania, Ghana and Kenya)
	Cost-effective for at least one country-specific threshold (but not all six)
	Not cost-effective at any of six country-specific thresholds, but not dominated
	Dominated

*Parameters where range of uncertainty in deterministic sensitivity analysis is the same as the PSA range. D: dominated, that is, intervention is more costly and less effective than the control.

ACT, artemisinin combination therapy; API, active pharmaceutical ingredient; CFR, case fatality rate; DALY, disability-adjusted life year; ICER, incremental cost-effectiveness ratio; PfPR, Plasmodium falciparum positivity rate; PSA, probabilistic sensitivity analysis; RDT, rapid diagnostic test.