Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists

Background: In 2010, the World Health Organization issued a guideline that calls for a shift from presumptive to test-based treatment. However, test-based treatment is still unpopular in community pharmacies. This could be due to unwillingness of customers to spend extra finance on rapid diagnostic test (RDT). It could also result from lack of interest from community pharmacists since they may perceive no financial gain attached to this service. This study assessed the cost-benefit of test-based malaria treatment to community pharmacists. Methods: The study was a community pharmacy-based cross sectional survey. Potential benefit of RDT was determined using customers' willingness-to-pay (WTP) for service. Average WTP was estimated using contingent valuation. Binary logistic regression was used to assess correlates of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. Cost associated with provision of RDT was estimated from provider's perspective. Probabilistic sensitivity analysis was used to capture parameter uncertainty. Benefit-cost ratio (BCR) was calculated to determine study objective. Results: A total of 135 out of 235 participants (57.4%) responded to the WTP question. Of this subset, 111 participants (82.2%) preferred RDT before malaria treatment. Average WTP [minimum-maximum] was US$1.23 [US$ 0.0-US$5.03]. Educated participants had 1.8 times higher odds of WTP for RDT. Participants that understood RDT as described in the questionnaire had 18.3 times higher odds of WTP for RDT compared to participants that did not understand RDT as described in the questionnaire. Additionally, a unit increase in level of education (e.g. from primary to secondary school) led to US$0.298 increase in WTP amount for RDT. Also, a unit increase in malaria frequency (e.g. from 'never' to 'rarely') led to US$0.293 decrease in WTP amount for RDT. Average cost [minimum-maximum] of RDT test kit and pharmacist time spent in administering the test were US$0.15 [US$0.13-US$0.17] and US$0.41 [US$0.18-US$0.52], respectively. BCR of test-based malaria treatment was 6.7 (95% CI 6.4-7.0). Conclusion: Test-based malaria treatment is cost-beneficial for pharmacy practitioners. This finding could be used as an advocacy tool to increase community pharmacists' interest and uptake of test-based malaria treatment.