Cost-Effectiveness of Strategies for the Diagnosis and Treatment of Febrile Illness in Children
Authors: Joseph Babigumira, Hellen Gelband, Louis P. Garrison, Jr.
This chapter assesses the cost-effectiveness of rapid diagnostic tests (RDTs) and their role in the treatment of febrile illness (FI) in children under age five years and finds that an RDT test-and-treat approach performs better than a microscopy test-and-treat approach. The model of this case study uses parameters specific to Tanzania (which can be generalized other Sub-Saharan African countries) and considers sequential treatment for FI in children who initially present with mild illness but return with severe illness. The model consists of (1) a “front-end” decision tree that classifies presenting children by their setting of treatment, point of care, diagnostic result, and treatment received, and (2) a “back-end” Markov model that estimates the impact of illness severity, progression, and mortality on costs and outcomes. Presumptive treatment of all children under age five years with fever, or only those who are severely ill, with both artemisinin-based combination therapies (ACTs) and a broad-spectrum antibiotic can minimize mortality and is projected to be highly cost-effective by global standards.