Cost Effectiveness of New Diagnostic Tools for Cutaneous Leishmaniasis in Afghanistan
Cost Effectiveness of New Diagnostic Tools for Cutaneous Leishmaniasis in Afghanistan
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DOI：
10.1007/s40258-018-0449-8
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发表时间：
2019-04-01
影响因子：
3.6
通讯作者：
Sicuri, Elisa
中科院分区：
文献类型：
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作者：
Aerts, Celine;Vink, Martijn;Sicuri, Elisa
背景和目的皮肤利什曼病是一种慢性的、毁容的皮肤病变，导致发病率和社会污名。诊断皮肤利什曼病的金标准是显微镜，但具有可变的敏感性，需要训练有素的人员。使用四种方案，本研究的目的是比较显微镜和两种新工具：Loopamp利什曼病检测试剂盒(LAMP)和CL检测快速测试(RDT)的成本效益。方法在阿富汗喀布尔国家疟疾和利什曼病控制计划的诊所收集与这些工具的成本和准确性相关的数据。有效性评估是基于工具的性能来衡量的，但也间接地使用了残疾调整后的寿命年。在TreeAge Healthcare Pro 2016中设计了一棵决策树，结合代表皮肤利什曼病自然历史的马尔可夫模型。除了确定性分析外，还进行了单变量敏感性和概率分析，以检验结果的稳健性。结果如果在国家疟疾和利什曼病控制计划的低发期对这些工具进行比较，显微镜检查仍然是首选。LAMP在皮肤利什曼病季节或暴发期间变得更合适，因为它一次处理多个测试(例如，最多48个)的能力可以最大化。RDT在参考诊所使用时的成本与显微镜相似，但由于它相对容易使用，它可以在外围水平实施，这将变得比在参考诊所使用显微镜更便宜。此外，对于阴性疑似患者，在参考诊所将RDT与显微镜或LAMP联合使用比在参考临床直接对所有疑似皮肤利什曼病患者进行LAMP或显微镜检查更具经济意义。结论当两者发挥各自优势时，LAMP和RDT可以证明是比在参考诊所单独使用显微镜更具成本效益的替代方案。
Background and ObjectivesCutaneous leishmaniasis is responsible for chronic and disfiguring skin lesions resulting in morbidity and social stigma. The gold standard to diagnose cutaneous leishmaniasis is microscopy but has a variable sensitivity and requires trained personnel. Using four scenarios, the objective of this study is to compare the cost effectiveness of microscopy with two new tools: Loopamp Leishmania Detection Kit (LAMP) and CL Detect Rapid Test (RDT).MethodsData related to the cost and accuracy of these tools were collected at the clinic of the National Malaria and Leishmaniasis Control Program in Kabul, Afghanistan. The effectiveness estimates were measured based on the tools' performance but also indirectly, using the disability-adjusted life years. A decision tree was designed in TreeAge Healthcare Pro 2016, combined with a Markov model representing the natural history of cutaneous leishmaniasis. In addition to a deterministic analysis, univariate sensitivity and probabilistic analyses were performed to test the robustness of the results.ResultsIf the tools are compared at the National Malaria and Leishmaniasis Control Program level in a period of low incidence, microscopy remains the preferred option. LAMP becomes more appropriate during cutaneous leishmaniasis seasons or outbreaks when its capacity to process several tests (e.g. up to 48) at a time can be maximised. RDT has a cost similar to microscopy when used at the reference clinic but as it is relatively easy to use, it could be implemented at the peripheral level, which would become cheaper than employing microscopy at the reference clinic. Moreover, combining RDT with microscopy or LAMP at the reference clinic for the negative suspects is economically more interesting than directly performing LAMP or microscopy respectively on all cutaneous leishmaniasis suspects at the reference clinic.ConclusionsWhen taking advantage of their respective strengths, LAMP and RDT can prove to be cost-effective alternatives to using microscopy alone at the reference clinic.