Economic evaluation of point-of-care diagnostic technologies for infectious diseases.

We review the growing number of economic evaluations of individual point-of-care (POC) tests for diagnosis of infectious diseases in resource-limited settings that use either cohort studies or mathematical models. We focus on studies that evaluate POC diagnostic tests for the control of human immunodeficiency virus (HIV) and malaria, tools that are central to the WHO prevention guidelines for infectious diseases in developing countries. Although rapid diagnostic tests for HIV and malaria seem to be cost-effective in these standard analyses, these do not take into account the reduction in patients' waiting time and the number of clinic visits required to receive results, or future benefits from the reduction in antimalarial drug pressure. Those additional cost reductions would be considerably greater with POC rapid tests, and the cost-effectiveness of POC tests would therefore be improved. Findings from cost-effectiveness analyses suggest that, despite the relatively small additional cost incurred, decision-makers should strongly consider using POC tests throughout or during parts of HIV and malaria epidemics, where this is feasible in terms of local human resources and logistical conditions.