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Cost-effectiveness of using a rapid diagnostic test to screen for human African trypanosomiasis in the Democratic Republic of the Congo

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  • Paul R Bessell
  • Crispin Lumbala
  • Pascal Lutumba
  • Sylvain Baloji
  • Sylvain Biéler
  • Joseph M Ndung'u

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.

Suggested Citation

  • Paul R Bessell & Crispin Lumbala & Pascal Lutumba & Sylvain Baloji & Sylvain Biéler & Joseph M Ndung'u, 2018. "Cost-effectiveness of using a rapid diagnostic test to screen for human African trypanosomiasis in the Democratic Republic of the Congo," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-18, September.
    • Handle: RePEc:plo:pone00:0204335
    DOI: 10.1371/journal.pone.0204335
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    References listed on IDEAS

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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    2. Francesco Checchi & François Chappuis & Unni Karunakara & Gerardo Priotto & Daniel Chandramohan, 2011. "Accuracy of Five Algorithms to Diagnose Gambiense Human African Trypanosomiasis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 5(7), pages 1-15, July.
    3. C Simone Sutherland & Joshua Yukich & Ron Goeree & Fabrizio Tediosi, 2015. "A Literature Review of Economic Evaluations for a Neglected Tropical Disease: Human African Trypanosomiasis (“Sleeping Sickness”)," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 9(2), pages 1-22, February.
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