Comparative cost-effectiveness of diagnostic tests for urinary schistosomiasis and the implications for school health programmes

The use of self-reported schistosomiasis or blood in urine has received a great deal of interest as a cheap and simple technique for diagnosing individuals infected with Schistosoma haematobium and identifying schools with a high prevalence of infection. Although the answers to questions about the signs and symptoms of urinary schistosomiasis have been shown to be good markers of parasitological infection, a formal cost-effectiveness analysis of their performance in relation to urine filtration and parasitological examination (assumed to be the gold standard) is lacking. Using empirical data on the costs and effectiveness of these techniques in 15 schools in Tanzania, the cost for every correct diagnosis or for every infected child identified was assessed. Although self-reported schistosomiasis was shown to be three times more cost-effective than urine filtration in identifying infected individuals, it would have resulted in a third of the infected children being missed. Use of self-reported schistosomiasis first to identify high-risk schools for mass treatment and then to identify infected children in low-risk schools (for individual treatment) also appeared more cost-effective than urine filtration and would have resulted in only 8% of the infected children not being treated. The use of self-reported schistosomiasis or self-reported blood in urine should be continually supported as a simple, cheap and cost-effective tool for identifying schools at high-risk of schistosomiasis.