Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, South Korea.
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-004292.
Rapid diagnostic tests (RDTs) are widely used for diagnosing malaria, especially in resource-limited countries. However, the impact of RDTs on malaria incidence and national medical costs has not been evaluated. We assessed the impact of RDT implementation on malaria incidence and overall medical expenditures in South Korea and performed a cost-benefit analysis from the payer's perspective.
We developed a dynamic compartmental model for malaria transmission in South Korea using delay differential equations. Long latency and seasonality were incorporated into the model, which was calibrated to civilian malaria incidences during 2014-2018. We then estimated averted malaria cases and total medical costs from two diagnostic scenarios: microscopy only and both microscopy and RDTs. Medical costs were extracted based on data from a hospital in an at-risk area for malaria and were validated using Health Insurance Review and Assessment Service data. We conducted a cost-benefit analysis of RDTs using the incremental benefit:cost ratio (IBCR) considering only medical costs and performed a probabilistic sensitivity analysis to reflect the uncertainties of model parameters, costs and benefits.
The results showed that 55.3% of new malaria cases were averted, and $696 214 in medical costs was saved over 10 years after RDT introduction. The estimated IBCR was 2.5, indicating that RDT implementation was beneficial, compared with microscopy alone. The IBCR was sensitive to the diagnosis time reduction, infectious period and short latency period, and provided beneficial results in a benefit over $10.6 or RDT cost under $39.7.
The model simulation suggested that RDTs could significantly reduce malaria incidence and medical costs. Moreover, cost-benefit analysis demonstrated that the introduction of RDTs was beneficial over microscopy alone. These results support the need for widespread adoption of RDTs.
快速诊断检测（RDT）广泛用于诊断疟疾，特别是在资源有限的国家。然而，RDT 对疟疾发病率和国家医疗费用的影响尚未得到评估。我们评估了 RDT 的实施对韩国疟疾发病率和总体医疗支出的影响，并从支付者的角度进行了成本效益分析。
我们使用时滞微分方程为韩国疟疾传播建立了一个动态房室模型。模型中纳入了长潜伏期和季节性，该模型通过 2014 年至 2018 年期间平民疟疾发病率进行了校准。然后，我们根据疟疾高危地区一家医院的数据，从两种诊断方案（仅显微镜检查和显微镜检查加 RDT）估计了可避免的疟疾病例和总医疗费用。我们仅考虑医疗费用，使用增量收益：成本比（IBCR）对 RDT 进行了成本效益分析，并进行了概率敏感性分析，以反映模型参数、成本和收益的不确定性。
结果表明，在引入 RDT 后 10 年内，新的疟疾病例中有 55.3%得到了避免，医疗费用节省了 696214 美元。与仅显微镜检查相比，估计的 IBCR 为 2.5，表明 RDT 的实施是有益的。IBCR 对诊断时间减少、传染期和短潜伏期敏感，在收益超过 10.6 美元或 RDT 成本低于 39.7 美元时提供了有益的结果。
模型模拟表明，RDT 可显著降低疟疾发病率和医疗费用。此外，成本效益分析表明，与仅显微镜检查相比，引入 RDT 是有益的。这些结果支持广泛采用 RDT 的需求。
