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Simulations Show Diagnostic Testing For Malaria In Young African Children Can Be Cost-Saving Or Cost-Effective
Victoria Phillips1, Joseph Njau2, Shang Li3
1Victoria Phillips (vphil01@sph.emory.edu) is an associate professor in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University, in Atlanta, Georgia.
Insights
Malaria diagnostic testing for young children is cost-saving in Angola and cost-effective in Tanzania and Uganda. These findings support the World Health Organization's (WHO) recommendation for malaria testing in children under five.
Area of Science:
- Global Health
- Infectious Diseases
- Health Economics
Background:
- Malaria significantly impacts global health, especially in sub-Saharan Africa, disproportionately affecting young children.
- The World Health Organization (WHO) recommended diagnostic testing for suspected malaria in children under five in 2010.
- Barriers to implementing this policy include cost and concerns about health impact.
Purpose of the Study:
- To assess the cost-effectiveness of malaria diagnostic testing in children under five.
- To evaluate the policy's economic viability in Angola, Tanzania, and Uganda.
Main Methods:
- Utilized data from national Malaria Indicator Surveys.
- Developed two-stage microsimulation models for Angola, Tanzania, and Uganda.
- Estimated cost per life-year gained for malaria diagnostic testing.
Main Results:
- Diagnostic testing for malaria in children under five is cost-saving in Angola.
- In Tanzania, the cost per life-year gained is $5.54; in Uganda, it is $94.28.
- Projected costs for Tanzania and Uganda are below the WHO standard of $150 per life-year gained.
Conclusions:
- Malaria diagnostic testing in children under five is a cost-effective strategy in the studied African nations.
- Results remain robust under various assumptions, supporting policy implementation.
- Policies facilitating widespread malaria testing in young children are strongly recommended.
Abstract:
Malaria imposes a substantial global disease burden. It disproportionately affects sub-Saharan Africans, particularly young children. In an effort to improve disease management, the World Health Organization (WHO) recommended in 2010 that countries test children younger than age five who present with suspected malaria fever to confirm the diagnosis instead of treating them presumptively with antimalarial drugs. Costs and concerns about the overall health impact of such diagnostic testing for malaria in children remain barriers to full implementation. Using data from national Malaria Indicator Surveys, we estimated two-stage microsimulation models for Angola, Tanzania, and Uganda to assess the policy's cost-effectiveness. We found that diagnostic testing for malaria in children younger than five is cost-saving in Angola. In Tanzania and Uganda the cost per life-year gained is $5.54 and $94.28, respectively. The costs projected for Tanzania and Uganda are less than the WHO standard of $150 per life-year gained. Our results were robust under varying assumptions about cost, prevalence of malaria, and behavior, and they strongly suggest the pursuit of policies that facilitate full implementation of testing for malaria in children younger than five.
