Abstract
BackgroundDengue fever is rapidly expanding geographically, with about half of the world’s population now at risk. Among the various diagnostic options, rapid diagnostic tests (RDTs) are convenient and prompt, but limited in terms of accuracy and availability.MethodsA systematic review was conducted of published data on the use of RDTs for dengue with respect to their economic impact. The search was conducted with combinations of key search terms, including “((Dengue[Title]) AND cost/economic)” and “rapid diagnostic test/assay (or point-of-care)”. Articles with insufficient report on cost/economic aspect of dengue RDTs, usually on comparison of different RDTs or assessment of novel rapid diagnostic tools, were excluded. This review has been registered in the PROSPERO International prospective register of systematic reviews (registry #: CRD42015017775).ResultsEleven articles were found through advanced search on Pubmed. From Embase and Web of Science, two and 14 articles were obtained, respectively. After removal of duplicate items, title screening was done on 21 published works and 12 titles, including 2 meeting abstracts, were selected for abstract review. For full-text review, by two independent reviewers, 5 articles and 1 meeting abstract were selected. Among these, the abstract was referring to the same study results as one of the articles. After full text review, two studies (two articles and one abstract) were found to report on cost-wise or economic benefits of dengue RDTs and were selected for data extraction. One study found satisfactory performance of IgM-based Panbio RDT, concluding that it would be cost-effective in endemic settings. The second study was a modeling analysis and showed that a dengue RDT would not be advantageous in terms of cost and effectiveness compared to current practice of antibiotics prescription for acute febrile illness.ConclusionsDespite growing use of RDTs in research and clinical settings, there were limited data to demonstrate an economic impact. The available two studies reached different conclusions on the cost-effectiveness of dengue RDTs, although only one of the two studies reported outcomes from cost-effectiveness analysis of dengue and the other was considering febrile illness more generally. Evidence of such an impact would require further quantitative economic studies.
Highlights
Dengue fever is rapidly expanding geographically, with about half of the world’s population at risk
10 articles and 2 meeting abstracts were considered relevant and among these 5 articles were selected for full-text review and 1 meeting abstract was retained and, as an abstract, skipped the full-text review step
On review of the full text of the articles, it was found that only two studies reported quantitative or qualitative economic impact of rapid diagnostic tests (RDTs) use for dengue: one by Lubell et al and another by Mitra et al The second study was reported in an abstract and an article, the former being published first [51, 52]
Summary
Dengue fever is rapidly expanding geographically, with about half of the world’s population at risk. A mosquito-borne flavivirus infection caused by four related but antigenically distinct dengue viruses (DENVs, serotypes 1–4), is a major and rapidly increasing public health problem. The WHO Strategic Advisory Group of Experts (SAGE) on Immunization emphasized the need for estimation of the true burden of dengue disease, including cost of illness [6]. But mostly focused in countries in Asia and Latin America, with well-documented hyper-endemicity and a long history of dengue transmission, such as Thailand [21, 22], the Philippines [23], Brazil [24, 25], Mexico [26], and Colombia [27]. Most of the available burden data are from studies of the epidemiology and evidence based on economic studies is limited [28, 29]
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