Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy
Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy
复制标题
DOI：
10.2471/blt.07.042259
复制
发表时间：
2008-02-01
期刊：
影响因子：
--
通讯作者：
Mills, A
中科院分区：
文献类型：
--
作者：
Shillcutt, Samuel;Morel, Chantal;Mills, A
目的 评估撒哈拉以南非洲地区不同环境下推定治疗、现场标准显微镜检查和快速诊断测试 (RDT) 诊断疟疾的相对成本效益。 方法 我们使用决策树模型和概率敏感性分析，对农村卫生机构疑似疟疾的门诊患者进行分析。成本和影响包括 RDT 阳性患者（假设基于青蒿素的联合治疗）和 RDT 阴性发热患者（假设抗生素治疗）的成本和影响。如果干预措施成本更低、更有效，或者每个残疾调整生命年避免的增量成本低于 150 美元，则干预措施被定义为具有成本效益。数据来自已发表和未发表的来源，并辅以专家意见。研究结果表明，在恶性疟原虫寄生虫血症高流行的情况下，RDT 与推定治疗相比具有成本效益。决策者对疟疾患病率低于 81% 的结果至少有 50% 的置信度，对患病率低于 62% 的结果有 95% 的置信度，这一水平在实践中很少超过。在流行率低于 58% 的情况下，RDT 可能会节省 50% 以上的成本。相对于显微镜检查，RDT 在所有患病率水平上都具有超过 85% 的成本效益，这反映了其在现实生活条件下预期更高的准确性。结果对于广泛的敏感性分析是稳健的。 RDT 的成本效益主要反映了非疟疾发热性疾病治疗和健康结果的改善，以及抗疟药物成本的节省。结果取决于处方者使用测试结果来指导治疗决策的假设。 结论 RDT 在撒哈拉以南非洲的大部分地区具有成本效益。为了获得这些检测的全部益处，需要对疟疾和非疟疾发热性疾病进行适当的管理。
Objective To evaluate the relative cost-effectiveness in different sub-Saharan African settings of presumptive treatment, field-standard microscopy and rapid diagnostic tests (RDTs) to diagnose malaria.Methods We used a decision tree model and probabilistic sensitivity analysis applied to outpatients presenting at rural health facilities with suspected malaria. Costs and effects encompassed those for both patients positive on RDT (assuming artemisinin-based combination therapy) and febrile patients negative on RDT (assuming antibiotic treatment). Interventions were defined as cost-effective if they were less costly and more effective or had an incremental cost per disability-adjusted life year averted of less than US$ 150. Data were drawn from published and unpublished sources, supplemented with expert opinion.Findings RDTs were cost-effective compared with presumptive treatment up to high prevalences of Plasmodium falciparum parasitaemia. Decision-makers can be at least 50% confident of this result below 81% malaria prevalence, and 95% confident below 62% prevalence, a level seldom exceeded in practice. RDTs were more than 50% likely to be cost-saving below 58% prevalence. Relative to microscopy, RDTs were more than 85% likely to be cost-effective across all prevalence levels, reflecting their expected better accuracy under real-life conditions. Results were robust to extensive sensitivity analysis. The cost-effectiveness of RDTs mainly reflected improved treatment and health outcomes for non-malarial febrile illness, plus savings in antimalarial drug costs. Results were dependent on the assumption that prescribers used test results to guide treatment decisions.Conclusion RDTs have the potential to be cost-effective in most parts of sub-Saharan Africa. Appropriate management of malaria and non-malarial febrile illnesses is required to reap the full benefits of these tests.