Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200433, China.
Department of Statistical Science, University College London, WC1E 6BT, London, UK.
Infect Dis Poverty. 2020 Sep 29;9(1):135. doi: 10.1186/s40249-020-00745-9.
As more and more countries approaching the goal of malaria elimination, malaria rapid diagnostic tests (RDT) was recomendated to be a diagnostic strategy to achieve and maintain the statute of malaria free, as it's less requirments on equipment and experitise than microscopic examination. But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination. This research aimed to offer evidence for helping decision making on malaria diagnosis strategy.
A cost-effectiveness analysis was conducted to compare RDT with microscopy examination for malaria diagnosis, by using a decision tree model. There were three strategies of malaria diagnostic testing evaluated in the model, 1) microscopy, 2) RDT, 3) RDT followed by microscopy. The effect indicator was defined as the number of malaria cases treated appropriately. Based on the joint perspective of health sector and patient, costs data were collected from hospital information systems, key informant interviews, and patient surveys. Data collection was conducted in Jiangsu from September 2018 to January 2019. Epidemiological data were obtained from local malaria surveillance reports. A hypothetical cohort of 300 000 febrile patients were simulated to calculate the total cost and effect of each strategy. One-way, two-way, and probabilistic sensitivity analysis were performed to test the robustness of the result.
The results showed that RDT strategy was the most effective (245 cases) but also the most costly (United States Dollar [USD] 4.47 million) compared to using microscopy alone (238 cases, USD 3.63 million), and RDT followed by microscopy (221 cases, USD 2.75 million). There was no strategy dominated. One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria. The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability.
Compared to microscopy and RDT followed by microscopy, RDT strategy had higher effects and higher cost in the setting of malaria elimination.
随着越来越多的国家接近消除疟疾的目标，疟疾快速诊断检测（RDT）被推荐作为一种诊断策略，以实现和维持无疟疾状态，因为它对设备和专业知识的要求低于显微镜检查。但是，很少有经济评估来确认 RDT 在消除疟疾的背景下是否具有成本效益。本研究旨在为帮助制定疟疾诊断策略的决策提供证据。
采用决策树模型，对 RDT 与显微镜检查用于疟疾诊断的成本效益进行了分析。模型中评估了三种疟疾诊断检测策略，1）显微镜检查，2）RDT，3）RDT 后显微镜检查。效果指标定义为适当治疗的疟疾病例数。基于卫生部门和患者的联合视角，从医院信息系统、关键知情人访谈和患者调查中收集成本数据。数据收集于 2018 年 9 月至 2019 年 1 月在江苏进行。从当地疟疾监测报告中获得流行病学数据。模拟了一个 300000 例发热患者的假设队列，以计算每个策略的总成本和效果。进行了单因素、双因素和概率敏感性分析，以测试结果的稳健性。
结果表明，与单独使用显微镜（238 例，3.63 百万美元）相比，RDT 策略（245 例，4.47 百万美元）最有效，但也最昂贵，RDT 后显微镜检查（221 例，2.75 百万美元）。没有一种策略占主导地位。单因素敏感性分析表明，结果对劳动力成本的变化敏感，双因素敏感性分析表明，结果对间日疟原虫的比例不敏感。蒙特卡罗模拟的结果表明，RDT 策略在消除疟疾的背景下具有更高的效果和更高的成本，概率很高。
与显微镜检查和 RDT 后显微镜检查相比，RDT 策略在消除疟疾的背景下具有更高的效果和更高的成本。
