Will patients be willing to pay up for the new malaria tests?

21 Jan 2010

Paul Chinnock

Source: International Journal for Equity in Health (see original article or PDF)

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Citation: Uzochukwu BS, Onwujekwe OE, Uguru NP, Ughasoro MD, Ezeoke OP (2010). Willingness to pay for rapid diagnostic tests for the diagnosis and treatment of malaria in southeast Nigeria: ex post and ex ante. International Journal for Equity in Health; 9:1.

Amongst the most important of the new tools available to fight malaria are rapid diagnostic tests (RDTs). These tests are easy to use on the front line of health care and should enable health workers to proceed with malaria treatment after a confirmed diagnosis, and not on the presumption (often incorrect) that every case of fever is malaria. Patients who test negative with an RDT will also benefit, because they can be given more appropriate treatment.

However, in many malaria-endemic countries it will be necessary for patients or their families to pay for an RDT to be used. Will they be willing to do so? Very little research has been done on willingness to pay (WTP), which often of course reflects ability to pay. A study from eastern Nigeria is therefore of interest.

Researchers assessed the WTP of 618 patients at health centres in both urban and rural locations immediately following diagnosis of malaria with an RDT. For comparison, they also assessed WTP in 1020 householders with a prior history of malaria. They describe their two sets of figures respectively as “ex-post” (after the event) and “ex-ante” (before the event).

The patients and householders were asked whether if they had a fever they would be willing to pay to be tested with a kit that gave an accurate result within 15 minutes. To determine how much they would be willing to pay, the researchers used a “bidding game” method which has previously been used in other studies. The market price was Naira 200 and the researchers marked this up by N100 for starting bids, and then increased or decreased by N100 Naira depending on the response. The respondents were allowed only three bids and the last bid was taken as their maximum WTP. (There are about N150 to the US dollar).

In the ex-ante group, 51% of the respondents in urban and 24.7% in rural areas were willing to pay for an RDT. The mean WTP was higher in urban (N235) than in rural areas (N182).

WTP was much higher in the ex-post group – 89% in urban and 91% in rural areas. The mean WTP was again higher in urban (N372) than in rural areas (N296).

The authors also analysed their figures according to socioeconomic status, finding unsurprisingly that poorer individuals tended to be less willing to pay.

It is encouraging that – “ex-post” – most people were willing to pay, and that the market cost of RDTs in Nigeria is lower than the average maximum amount they would pay. However, the findings suggest that there would be a substantial number of people who would miss out on the benefits of RDTs at the price currently being charged. It would clearly be better if the tests were available free. Malaria is responsible for a large financial burden on families, communities and whole nations, and the introduction of RDTs – together with insecticide-treated bednets and artemisinin-combination therapies –can potentially save money by reducing this burden.

As the authors rightly observe, “Governments and donors should be willing to commit funds to make RDTs affordable especially to the poorest consumers and other vulnerable members of the society if the intervention is to be used to significantly reduce the burden of malaria”. While noting that their study was conducted in just one part of Nigeria, they suggest that their findings may be useful for policy makers.

2010 Uzochukwu et al., licensee BioMed Central Ltd.