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Randomized Controlled Trial
. 2008 Jun;78(6):884-91.

Modeling the financial and clinical implications of malaria rapid diagnostic tests in the case-management of older children and adults in Kenya

Dejan Zurovac  1 , Bruce A Larson, Jacek Skarbinski, Laurence Slutsker, Robert W Snow, Mary J Hamel
Affiliations
Randomized Controlled Trial

Modeling the financial and clinical implications of malaria rapid diagnostic tests in the case-management of older children and adults in Kenya

Dejan Zurovac et al. Am J Trop Med Hyg. 2008 Jun.

Abstract

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.

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Figures

Figure 1
Figure 1
Clinical process scenarios* for outpatients 5 years and older in Bondo/Siaya districts (high malaria transmission area). * In each box variable is defined, notation for the variable and parameter assumptions are specified, and values in decimal points for each of 3 scenarios are presented. RDT = rapid diagnostic test; BS = blood slide; AL = artemether-lumefantrine; AM = antimalarial (other than artemether-lumefantrine); AB = antibiotic.
Figure 2
Figure 2
Clinical process scenarios* for outpatients 5 years and older in Kericho district (low malaria transmission area). * In each box variable is defined, notation for the variable and parameter assumptions are specified and values in decimal points for each of 3 scenarios are presented.
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