Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?
Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?
复制标题
DOI：
10.1186/1475-2875-7-176
复制
发表时间：
2008-09-15
期刊：
影响因子：
3
通讯作者：
Barnes, Karen I.
中科院分区：
文献类型：
--
作者：
Zikusooka, Charlotte M.;McIntyre, Diane;Barnes, Karen I.
背景资料：在抗疟费用增加和/或疟疾传播减少的背景下，将抗疟治疗仅限于那些被证实患有疟疾寄生虫的人变得至关重要。这促使这种评估的成本效益的常规使用的快速诊断检测（RDTs）的一个组成部分部署青蒿素为基础的联合疗法（ACTs）。方法：使用RDTs的成本和成本效益，以限制那些谁实际上有恶性疟原虫寄生虫病在莫桑比克南部的两个地区的ACTs的使用进行了评估。为了评估采用RDT（成本0.95美元）进行明确诊断的潜在影响，考虑了五种情况，假设使用明确诊断将发现25%至75%的临床诊断疟疾患者被证实为寄生虫病。基础分析比较了两种青蒿素综合疗法，青蒿琥酯加磺胺嘧啶/乙胺嘧啶（AS+SP），每名成人治疗费用为1.77美元，蒿甲醚-苯芴醇（AL），每名成人治疗费用为2.40美元，以及将RDT的使用限制在6岁以上的选择。敏感性分析认为，成本较低的ACT和RDTs和不同的人口年龄distribution.Results：治疗患者的临床诊断的基础上，在所有临床诊断的疟疾病例中使用RDTs的结果节省成本时，只有29%和52%或更少的所有疑似疟疾病例的疟疾检测呈阳性，并分别与AS+SP和AL治疗。当RDT的使用仅限于6岁以上的儿童时，这些临界点增加到41.5%（AS+SP）和74%（AL）。当25%的临床诊断患者为RDT阳性并使用AL治疗时，每个疟疾阳性患者治疗的成本节省高达2.12美元。当29%以上的临床诊断病例疟疾检测呈阳性时，每名疟疾阳性患者治疗的增量成本不到1美元。当引入相对较便宜的ACT时（例如，G.目前世卫组织对急性白血病的优惠价格为每名成人治疗1.44美元），对于RDT，卫生保健提供者的RDT价格应为0.65美元或更低，以便在30%至52%的临床诊断疟疾病例为疟疾检测阳性的人群中节省成本。虽然在临床诊断的疟疾病例中，当寄生虫流行率为低至中等时，在所有疑似病例中使用快速诊断疗法已被证明可以节省费用，研究结果表明，以6岁以上的群体为目标，根据临床诊断治疗6岁以下的儿童，节省的费用更大。在半免疫人群中，幼儿患严重疟疾的风险最高，许多医疗保健提供者会发现很难拒绝向这个年龄组中检测呈阴性的人提供抗疟药物。
Background: Within the context of increasing antimalarial costs and or decreasing malaria transmission, the importance of limiting antimalarial treatment to only those confirmed as having malaria parasites becomes paramount. This motivates for this assessment of the cost-effectiveness of routine use of rapid diagnostic tests (RDTs) as an integral part of deploying artemisinin-based combination therapies (ACTs).Methods: The costs and cost-effectiveness of using RDTs to limit the use of ACTs to those who actually have Plasmodium falciparum parasitaemia in two districts in southern Mozambique were assessed. To evaluate the potential impact of introducing definitive diagnosis using RDTs (costing $0.95), five scenarios were considered, assuming that the use of definitive diagnosis would find that between 25% and 75% of the clinically diagnosed malaria patients are confirmed to be parasitaemic. The base analysis compared two ACTs, artesunate plus sulfadoxine/pyrimethamine (AS+SP) costing $1.77 per adult treatment and artemether-lumefantrine (AL) costing $2.40 per adult treatment, as well as the option of restricting RDT use to only those older than six years. Sensitivity analyses considered lower cost ACTs and RDTs and different population age distributions.Results: Compared to treating patients on the basis of clinical diagnosis, the use of RDTs in all clinically diagnosed malaria cases results in cost savings only when 29% and 52% or less of all suspected malaria cases test positive for malaria and are treated with AS+SP and AL, respectively. These cut-off points increase to 41.5% (for AS+SP) and to 74% (for AL) when the use of RDTs is restricted to only those older than six years of age. When 25% of clinically diagnosed patients are RDT positive and treated using AL, there are cost savings per malaria positive patient treated of up to $2.12. When more than 29% of clinically diagnosed cases are malaria test positive, the incremental cost per malaria positive patient treated is less than US$ 1. When relatively less expensive ACTs are introduced (e. g. current WHO preferential price for AL of $1.44 per adult treatment), the RDT price to the healthcare provider should be $0.65 or lower for RDTs to be cost saving in populations with between 30 and 52% of clinically diagnosed malaria cases being malaria test positive.Conclusion: While the use of RDTs in all suspected cases has been shown to be cost-saving when parasite prevalence among clinically diagnosed malaria cases is low to moderate, findings show that targeting RDTs at the group older than six years and treating children less than six years on the basis of clinical diagnosis is even more cost-saving. In semi-immune populations, young children carry the highest risk of severe malaria and many healthcare providers would find it harder to deny antimalarials to those who test negative in this age group.