%0 Journal Article
%T Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso
%A Zeno Bisoffi
%A Sodiomon B Sirima
%A Filip Meheus
%A Claudia Lodesani
%A Federico Gobbi
%A Andrea Angheben
%A Halidou Tinto
%A Bouma Neya
%A Klara Van den Ende
%A Annalisa Romeo
%A Jef Van den Ende
%J Malaria Journal
%D 2011
%I BioMed Central
%R 10.1186/1475-2875-10-226
%X A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT) recruiting 852 febrile patients during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis.At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525 ? for a death averted, the total cost of managing 1,000 febrile children was 1,747 vs. 1,862 ? in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the RDT would be the winning strategy for adults in both seasons and for children in the dry season.At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in patients with false positive RDT results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For children the presumptive strategy remains the best choice for a wide range of scenarios.For RDTs to be preferred, a positive result should not influence the decision to treat a potentially severe NMFI with antibiotics. In the rainy season the presumptive strategy always remains the better choice for children.Several economic studies have been carried out on malaria management with rapid diagnostic tests (RDTs) as a guide to initiate treatment, compared with the previously common presumptive approach and/or with microscopy [1-9]. RDTs have generally been found to be accurate, reliable and cost effective. New WHO guidelines on malaria management [10] state that a
%U http://www.malariajournal.com/content/10/1/226