Abstract
New rapid diagnostic tests (RDTs) for screening human African trypanosomiasis (HAT) have been introduced as alternatives to the card agglutination test for trypanosomiasis (CATT). One brand of RDT, the SD BIOLINE HAT RDT has been shown to have lower specificity but higher sensitivity than CATT, so to make a rational choice between screening strategies, a cost-effectiveness analysis is a key element. In this paper we estimate the relative cost-effectiveness of CATT and the RDT when implemented in the Democratic Republic of the Congo (DRC). Data on the epidemiological parameters and costs were collected as part of a larger study. These data were used to model three different diagnostic algorithms in mobile teams and fixed health facilities, and the relative cost-effectiveness was measured as the average cost per case diagnosed. In both fixed facilities and mobile teams, screening of participants using the SD BIOLINE HAT RDT followed by parasitological confirmation had a lower cost-effectiveness ratio than in algorithms using CATT. Algorithms using the RDT were cheaper by 112.54 (33.2%) and 88.54 (32.92%) US dollars per case diagnosed in mobile teams and fixed health facilities respectively, when compared with algorithms using CATT. Sensitivity analysis demonstrated that these conclusions were robust to a number of assumptions, and that the results can be scaled to smaller or larger facilities, and a range of prevalences. The RDT was the most cost-effective screening test in all realistic scenarios and detected more cases than CATT. Thus, on this basis, the SD BIOLINE HAT RDT could be considered as the most cost-effective option for use in routine screening for HAT in the DRC.
Highlights
Human African trypanosomiasis (HAT) or sleeping sickness is caused by two subspecies of the protozoan parasite Trypanosoma brucei
The optimal algorithm measured by the average cost-effectiveness ratio (ACER), by the cost per disability adjusted life years (DALYs) averted, and by the number of deaths averted for both mobile teams and fixed health facilities is the rapid diagnostic tests (RDTs) followed by a combination of microscopy tests (Table 2)
This study demonstrates that the most cost-effective algorithm for either active or passive screening for HAT is one that includes the SD BIOLINE HAT RDT followed by microscopy
Summary
Human African trypanosomiasis (HAT) or sleeping sickness is caused by two subspecies of the protozoan parasite Trypanosoma brucei This tsetse fly-transmitted disease is endemic in 36 sub-Saharan African countries. A core component of HAT elimination strategies is the screening of large numbers of individuals who are at risk of infection, to identify and treat cases and break the transmission cycle [3,4,5]. This is because the clinical signs of HAT are non-specific, and prevalence of the disease in most regions is relatively low [6]. Due to the relative toxicity of the drugs used and the onerous nature of the treatment, it is important to correctly identify infected individuals before they are given treatment
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