Malaria poses both economical and health implications for the health system in Zambia. Accurate diagnosis of the disease is key for prompt and effective case management. This study consists of an economic evaluation of the alternative malaria diagnosis methods in out patient clinics in Zambia. The impact of the antimalarial prescription practices on the cost-effectivenes of the diagnostic strategies are discussed. This information is relevant to professionals in most malaria endemic countries. The methodological approach is of interest also to health economists.