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Am. J. Trop. Med. Hyg., 78(6), 2008, pp. 884-891
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Modeling the Financial and Clinical Implications of Malaria Rapid Diagnostic Tests in the Case-management of Older Children and Adults in Kenya

Dejan Zurovac*, Bruce A. Larson, Jacek Skarbinski, Laurence Slutsker, Robert W. Snow, AND Mary J. Hamel
Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Center for International Health and Development, Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Using data on clinical practices for outpatients 5 years and older, test accuracy, and malaria prevalence, we model financial and clinical implications of malaria rapid diagnostic tests (RDTs) under the new artemether-lumefantrine (AL) treatment policy in one high and one low malaria prevalence district in Kenya. In the high transmission district, RDTs as actually used would improve malaria treatment (61% less over-treatment but 8% more under-treatment) and lower costs (21% less). Nonetheless, the majority of patients with malaria would not be correctly treated with AL. In the low transmission district, especially because the treatment policy was new and AL was not widely used, RDTs as actually used would yield a minor reduction in under-treatment errors (36% less but the base is small) with 41% higher costs. In both districts, adherence to revised clinical practices with RDTs has the potential to further decrease treatment errors with acceptable costs.

Received December 5, 2007. Accepted for publication February 27, 2008.

Acknowledgments: The authors thank all health workers, patients, and parents of sick children who participated in the initial study. Robert W. Snow is supported by the Wellcome Trust as Principal Research Fellow (#079081). The authors thank David Hamer for comments on the paper. This paper is published with the permission of the director of KEMRI.

Financial support: This study received financial support from USAID, The Wellcome Trust, UK, and the Kenya Medical Research Institute.

* Address correspondence to Dejan Zurovac, Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute/Wellcome Trust Research Research Programme, PO Box 43640, GPO 00100, Nairobi, Kenya. E-mail: dzurovac{at}nairobi.kemri-wellcome.org

Note: A supplemental appendix "Modeling expected costs and AL treatment errors" appears online at www.ajtmh.org.

Authors’ addresses: Dejan Zurovac and Robert W. Snow, Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute/Wellcome Trust Research Research Programme, PO Box 43640, GPO 00100, Nairobi, Kenya, Tel: 254-20-271-51-60, Fax: 254-20-271-16-73, E-mails: dzurovac{at}nairobi.kemri-wellcome.org and rsnow{at}nairobi.kemri-wellcome.org. Bruce A. Larson, Department of International Health, School of Public Health, and the Center for International Health and Development, Boston University, 85 East Concord Street, 5th Floor, Boston, MA 02118, Tel: 1-617-414-1457, Fax: 1-617-414-1261, E-mail: blarson{at}bu.edu. Jacek Skarbinski, Laurence Slutsker, and Mary J. Hamel, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3724, Tel: 1-770-488-7785; Fax: 1-770-488-7761, E-mails: dvo5{at}CDC.GOV, lms5{at}CDC.GOV, andMhamel{at}ke.cdc.gov.




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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.