Economic evaluation of a cluster randomized trial of interventions to improve health workers' practice in diagnosing and treating uncomplicated malaria in Cameroon.
BACKGROUND
Malaria rapid diagnostic tests (RDTs) are a valid alternative to malaria testing with microscopy and are recommended for the testing of febrile patients before prescribing an antimalarial. There is a need for interventions to support the uptake of RDTs by health workers.


OBJECTIVE
To evaluate the cost-effectiveness of introducing RDTs with basic or enhanced training in health facilities in which microscopy was available, compared with current practice.


METHODS
A three-arm cluster randomized trial was conducted in 46 facilities in central and northwest Cameroon. Basic training had a practical session on RDTs and lectures on malaria treatment guidelines. Enhanced training included small-group activities designed to change health workers' practice and reduce the consumption of antimalarials among test-negative patients. The primary outcome was the proportion of febrile patients correctly treated: febrile patients should be tested for malaria, artemisinin combination therapy should be prescribed for confirmed cases, and no antimalarial should be prescribed for patients who are test-negative. Individual patient data were obtained from facility records and an exit survey. Costs were estimated from a societal perspective using project reports and patient exit data. The analysis used bivariate multilevel modeling and adjusted for imbalance in baseline covariates.


RESULTS
Incremental cost per febrile patient correctly treated was $8.40 for the basic arm and $3.71 for the enhanced arm. On scale-up, it was estimated that RDTs with enhanced training would save $0.75 per additional febrile patient correctly treated.


CONCLUSIONS
Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice.
['Mangham-Jefferies|Lindsay|L|', 'Wiseman|Virginia|V|', 'Achonduh|Olivia A|OA|', 'Drake|Thomas L|TL|', 'Cundill|Bonnie|B|', 'Onwujekwe|Obinna|O|', 'Mbacham|Wilfred|W|']
D000293:Adolescent D000328:Adult D000962:Antimalarials D037621:Artemisinins D002163:Cameroon D002648:Child D002675:Child, Preschool D003362:Cost-Benefit Analysis D003955:Diagnostic Tests, Routine D004359:Drug Therapy, Combination D005260:Female D005334:Fever D006268:Health Facilities D006282:Health Personnel D006801:Humans D007223:Infant D007318:Inservice Training D008288:Malaria D016778:Malaria, Falciparum D008297:Male D008875:Middle Aged D055815:Young Adult
practice malaria Cameroon cluster-randomized trial cost-effectiveness analysis health worker training