The objectives of this research are to investigate themagnitude and components of direct operating cost incurred byinstitutions, analyze the outcomes in terms of the number ofblood sides examined and the number of positive cases detected,additional direct costs needed for additional cases detected,changes of unit costs with changes of slide positive rates andnumber of fever of unknown origin (FUO) patients in two schemes A(malaria, suspected malaria, FUO) and B (malaria, suspectedmalaria) for malaria case detection in China. The data from twocounties were used for a micro-level study, the performance datafrom 23 counties of 12 provinces in a nationwide survey were usedin a macro-level study. The personnel costs were the largest components in the twocounties and two schemes. In County A, personnel cost took up75.8% of the total direct costs (Scheme A), 98.5% in Scheme B

96.2% in Country B (Scheme B)

in Country A, the costs ofresources used by the FUO were 99.2% of the total direct costs.In the two counties, the slide positive rates (SPR) for typicalmalaria were both 100%

for suspected malaria, 10.0% in CountryA, 26,2%.in Country B

for FUO in County A, 0%. The cost perslide examined (CPSE) was 10.4 Yuan in Country A (Scheme A),134.4 Yuan in Country B

the cost per positive case detected(CPPCD) was 5,816.5 Yuan in Country A, 304.6 Yuan in Country B.In Country A, the institution spent 48233.7 Yuan as additionaldirect costs but no additional positive case was detected fromFUO in 1993. Assuming the two schemes were carried out in thesame county, when SPR is less or greater than a particularvalue, according to whether Scheme B or A has a lower CPPCD,Scheme B or A should be used if we consider the total operatingcost for missed cases in FUO and vice versa. With the increasingchanges in number of FUO, under the assumptions made, if Scheme Awas implemented, the CPSE showed a increasing trend

the CPPCDshowed a decreasing trend. The study showed that it would save48,183.67 Yuan if County A implemented Scheme B rather thanScheme A. If Scheme B was implemented in all counties inbasically eliminated malaria areas, the cost saving will be veryconsiderable, but it may miss some positive cases in FUO.