Efficiency of different detection strategies of Human African trypanosomiasis at T-b. gambiense
Efficiency of different detection strategies of Human African trypanosomiasis at T-b. gambiense
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DOI：
10.1111/j.1365-3156.2005.01391.x
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发表时间：
2005-04-01
影响因子：
3.3
通讯作者：
Boelaert, M
中科院分区：
文献类型：
--
作者：
Lutumba, P;Robays, J;Boelaert, M
人类非洲锥虫（HAT）的人群筛查通常基于两种筛查试验的组合：淋巴结触诊（LN）和锥虫卡凝集试验（CATT）。该决策分析比较了三种备选检测策略的效率：仅用LN筛查、仅用CATT筛查以及LN和CATT联合筛查。根据挽救的生命来评价疗效。筛查和确认检测的费用以美元估算。决策树中的不同参数基于已发表的文献和对刚果民主共和国HAT控制方案的观察。对这些参数进行了灵敏度分析，受到不确定性。结果的成本效益的检测策略的基础上CATT是125美元每挽救生命，相比之下，LN和452美元的组合为517美元。仅在CATT中添加LN的边际成本为每挽救一条生命1225美元至5000美元。敏感性分析表明，这些结果是强大的variation.Discussion的CATT策略是最有效的。没有一种策略能够避免超过60%的HAT死亡。这种中等疗效是由于确认（诊断）试验的敏感性低。通过采取仅采用CATT的战略，可以获得显著的效率增益，并且可以更好地将资源分配给更敏感的验证性测试或增加风险人群的覆盖面。
Introduction Population screening for human African trypanosomiasis (HAT) is often based on a combination of two screening tests: lymph node palpation (LN) and card agglutination test for trypanosomiasis (CATT). This decision analysis compared the efficiency of three alternative detection strategies: screening by LN only, CATT only and their combination (LN and CATT).Method An HAT detection strategy was defined as the sequence of screening and confirmation. Efficacy was evaluated in terms of lives saved. The cost of screening and confirmation tests was estimated in US$. The different parameters in the decision tree were based on published literature and observations of the HAT control programme in the Democratic Republic of Congo. A sensitivity analysis was carried out on those parameters subject to uncertainty.Results The cost-effectiveness of a detection strategy based on CATT was US$125 per life saved, compared with US$517 for LN and US$452 for the combined. Marginal cost to add LN to CATT only was between US$1225 and US$5000 per life saved. Sensitivity analysis shows that these results are robust to variation.Discussion The CATT strategy was the most efficient. None of the strategies was able to avoid more than 60% of HAT deaths. This moderate efficacy is due to the low sensitivity of the confirmatory ( diagnostic) tests. Substantial efficiency gains can be obtained by adopting a CATT only strategy and resources can be better allocated to more sensitive confirmatory tests or to increasing the coverage of populations at risk.