BACKGROUND: Malaria rapid diagnostic tests (RDTs) have generally been found reliable and cost-effective. In Burkina Faso, the adherence of prescribers to the negative test result was found to be poor. Moreover, the test accuracy for @entity311 -attributable fever (MAF) is not the same as for @entity281 . This paper aims at determining the costs and benefits of two competing strategies for the management of MAF: presumptive treatment for all or use of RDTs. METHODS: A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT) recruiting 852 febrile @entity1 during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis. RESULTS AND DISCUSSION: At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525     for a death averted, the total cost of managing 1,000 febrile @entity1 was 1,747 vs. 1,862     in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the @entity138 would be the winning strategy for adults in both seasons and for @entity1 in the dry season.At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in @entity1 with false positive @entity138 results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For @entity1 the presumptive strategy remains the best choice for a wide range of scenarios. CONCLUSIONS: For RDTs to be preferred, a positive result should not influence the decision to treat a potentially severe NMFI with antibiotics. In the rainy season the presumptive strategy always remains the better choice for @entity1 .

Strict adherence to XXXX rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso.

@entity1 :: ('9606', 'Species') :: ['children', 'patients'] @entity311 :: ('MESH:D008288', 'Disease') :: ['malaria'] @entity281 :: ('MESH:D007239', 'Disease') :: ['malaria infection'] @entity138 :: ('MESH:C563738', 'Disease') :: ['RDT']
@entity311 :: (MESH:D008288,Disease) :: ['malaria']
