BMJ  2008;336:168-169 (26 January), doi:10.1136/bmj.39401.486655.80 (published 16 January 2008)

Editorials

Costs of treating malaria according to test results

Improving diagnostic tests can reduce costs but only if adherence to test results is also improved

The first 150 words of the full text of this article appear below.

In the accompanying study, Lubell and colleagues assess the effect of clinicians’ adherence to the results of a rapid diagnostic test or microscopy on the overall costs of the management of malaria in Tanzania.1

In recent years, most treatment policies for malaria in Africa have shifted to artemisinin combination treatments, which are highly effective but more expensive than older regimens. To avoid over prescription, current guidelines recommend that the diagnosis should be confirmed with a laboratory test before treatment. Immunochromatographic tests for malaria allow diagnosis to be made even in health settings that lack laboratory facilities. Economic models and decision making models support the use of these tests.234 However, models generally assume that clinicians or nurse practitioners fully adhere to the test result when deciding how to manage the patient. But evidence proves the opposite—clinicians are likely to treat people for malaria even after negative results from rapid diagnostic tests . . . [Full text of this article]

Zeno Bisoffi, head of the centre for tropical diseases1, Jef Van den Ende, head of the department of clinical sciences2

1 S Cuore Hospital, 37024 Negrar, Verona, Italy, 2 Institute of Tropical Medicine, Nationalestraat 155-B-2000 Antwerp, Belgium

zeno.bisoffi@sacrocuore.it


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