Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model.
Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model.
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DOI：
10.1371/journal.pone.0293077
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
埃博拉病毒病（EVD）没有明显的临床症状，这促使开发了快速筛查工具，或呼吁采用新的方法来筛查疑似埃博拉病例。新的筛查方法需要临床效益和经济效率的证据。到目前为止，没有证据或定义的算法存在。从医疗保健的角度，评估在爆发期间将埃博拉预测评分和快速诊断测试纳入EVD筛查算法的效率。我们收集了快速诊断测试（RDTs）和预测分数准确性测量的数据，例如，敏感性和特异性，以及病例管理和EVD可疑病例中RDT筛查的成本。计算每例疑似患者的医疗服务总成本（PPE、手术时间和标准治疗（SOC）成本）和EVD诊断确认。我们还从文献中收集了疑似EVD的患病率。我们创建了一个分析决策模型来评估八种筛选策略的效率：1）根据世卫组织埃博拉疑似病例定义筛查疑似病例，2）在-3个临界点时使用ECPS筛查疑似病例，3）使用ECPS作为联合检测筛查疑似病例，4）使用ECPS作为条件检测筛查疑似病例，5）用WHO病例定义筛选疑似病例，然后用QuickNavi™-埃博拉RDT，6）用-3个截止点的ECPS和QuickNavi™-埃博拉RDT筛选疑似病例，7）用作为条件测试的ECPS和QuickNavi™-埃博拉RDT筛选疑似病例，和8）用ECPS作为联合测试和QuickNavi™-埃博拉RDT筛查可疑病例。我们进行了成本效益分析，以确定一种算法，最大限度地减少每个病人的成本正确分类。我们进行了单向和概率敏感性分析，以测试我们的研究结果的鲁棒性。我们的分析发现，双重ECPS作为QuickNavi™-Ebola RDT算法的条件测试是EVD最具成本效益的筛查算法，有效性为0.86。成本-效果比为106.7美元，每名患者正确分类。以下算法，ECPS作为条件检验，有效性为0.80，效率为111.5美元/患者，正确分类，ECPS作为与QuickNavi™-埃博拉RDT算法的联合检验，有效性为0.81，成本效益比为131.5美元/患者，正确分类。这些发现对疑似人群中EVD患病率的变化以及QuickNavi™-Ebola RDT的灵敏度敏感。这项研究的结果表明，预测评分和RDT可以改善埃博拉筛查。使用ECPS作为条件测试算法和双ECPS作为条件测试，然后使用QuickNavi™-埃博拉RDT算法是最佳的筛查选择，因为它们更有效，并且在EBOV流行期间降低了确认测试的数量和总体护理成本。
No distinctive clinical signs of Ebola virus disease (EVD) have prompted the development of rapid screening tools or called for a new approach to screening suspected Ebola cases. New screening approaches require evidence of clinical benefit and economic efficiency. As of now, no evidence or defined algorithm exists. To evaluate, from a healthcare perspective, the efficiency of incorporating Ebola prediction scores and rapid diagnostic tests into the EVD screening algorithm during an outbreak. We collected data on rapid diagnostic tests (RDTs) and prediction scores’ accuracy measurements, e.g., sensitivity and specificity, and the cost of case management and RDT screening in EVD suspect cases. The overall cost of healthcare services (PPE, procedure time, and standard-of-care (SOC) costs) per suspected patient and diagnostic confirmation of EVD were calculated. We also collected the EVD prevalence among suspects from the literature. We created an analytical decision model to assess the efficiency of eight screening strategies: 1) Screening suspect cases with the WHO case definition for Ebola suspects, 2) Screening suspect cases with the ECPS at -3 points of cut-off, 3) Screening suspect cases with the ECPS as a joint test, 4) Screening suspect cases with the ECPS as a conditional test, 5) Screening suspect cases with the WHO case definition, then QuickNavi™-Ebola RDT, 6) Screening suspect cases with the ECPS at -3 points of cut-off and QuickNavi™-Ebola RDT, 7) Screening suspect cases with the ECPS as a conditional test and QuickNavi™-Ebola RDT, and 8) Screening suspect cases with the ECPS as a joint test and QuickNavi™-Ebola RDT. We performed a cost-effectiveness analysis to identify an algorithm that minimizes the cost per patient correctly classified. We performed a one-way and probabilistic sensitivity analysis to test the robustness of our findings. Our analysis found dual ECPS as a conditional test with the QuickNavi™-Ebola RDT algorithm to be the most cost-effective screening algorithm for EVD, with an effectiveness of 0.86. The cost-effectiveness ratio was 106.7 USD per patient correctly classified. The following algorithms, the ECPS as a conditional test with an effectiveness of 0.80 and an efficiency of 111.5 USD per patient correctly classified and the ECPS as a joint test with the QuickNavi™-Ebola RDT algorithm with an effectiveness of 0.81 and a cost-effectiveness ratio of 131.5 USD per patient correctly classified. These findings were sensitive to variations in the prevalence of EVD in suspected population and the sensitivity of the QuickNavi™-Ebola RDT. Findings from this study showed that prediction scores and RDT could improve Ebola screening. The use of the ECPS as a conditional test algorithm and the dual ECPS as a conditional test and then the QuickNavi™-Ebola RDT algorithm are the best screening choices because they are more efficient and lower the number of confirmation tests and overall care costs during an EBOV epidemic.
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DOI：
10.1056/nejmoa1411100
发表时间：
2014-10-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
WHO Ebola Response Team;Aylward B;Barboza P;Bawo L;Bertherat E;Bilivogui P;Blake I;Brennan R;Briand S;Chakauya JM;Chitala K;Conteh RM;Cori A;Croisier A;Dangou JM;Diallo B;Donnelly CA;Dye C;Eckmanns T;Ferguson NM;Formenty P;Fuhrer C;Fukuda K;Garske T;Gasasira A;Gbanyan S;Graaff P;Heleze E;Jambai A;Jombart T;Kasolo F;Kadiobo AM;Keita S;Kertesz D;Koné M;Lane C;Markoff J;Massaquoi M;Mills H;Mulba JM;Musa E;Myhre J;Nasidi A;Nilles E;Nouvellet P;Nshimirimana D;Nuttall I;Nyenswah T;Olu O;Pendergast S;Perea W;Polonsky J;Riley S;Ronveaux O;Sakoba K;Santhana Gopala Krishnan R;Senga M;Shuaib F;Van Kerkhove MD;Vaz R;Wijekoon Kannangarage N;Yoti Z
通讯作者：
Yoti Z
影响因子：
11.8
作者：
Genisca, Alicia E.;Chu, Tzu-Chun;Huang, Lawrence;Gainey, Monique;Adeniji, Moyinoluwa;Mbong, Eta N.;Kennedy, Stephen B.;Laghari, Razia;Nganga, Fiston;Muhayangabo, Rigo F.;Vaishnav, Himanshu;Perera, Shiromi M.;Colubri, Andres;Levine, Adam C.;Michelow, Ian C.
通讯作者：
Michelow, Ian C.
影响因子：
168.9
作者：
Broadhurst, Mara Jana;Kelly, John Daniel;Pollock, Nira R.
通讯作者：
Pollock, Nira R.
影响因子：
1.2
作者：
Katawera, Victoria;Kohar, Henry;Fall, Ibrahima Soce
通讯作者：
Fall, Ibrahima Soce
小儿埃博拉病毒预测评分的发展，塞拉利昂（1）。
影响因子：
11.8
作者：
Fitzgerald F;Wing K;Naveed A;Gbessay M;Ross JCG;Checchi F;Youkee D;Jalloh MB;Baion DE;Mustapha A;Jah H;Lako S;Oza S;Boufkhed S;Feury R;Bielicki J;Williamson E;Gibb DM;Klein N;Sahr F;Yeung S
通讯作者：
Yeung S