Lindsay Mangham-JefferiesVirginia WisemanOlivia A. AchonduhThomas L. DrakeBonnie CundillObinna OnwujekweWilfred MbachamLondon School of Hygiene & Tropical MedicineUniversite de Yaounde INuffield Department of Clinical MedicineMahidol UniversityUniversity of Nigeria2018-11-092018-11-092014-01-01Value in Health. Vol.17, No.8 (2014), 783-79115244733109830152-s2.0-84915784151https://repository.li.mahidol.ac.th/handle/20.500.14594/34784© 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). 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.Mahidol UniversityMedicineArticleSCOPUS10.1016/j.jval.2014.07.010