Chew Rusheng, Painter Chris, Pan-Ngum Wirichada, Day Nicholas Philip John, Lubell Yoel
Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Lancet Reg Health Southeast Asia. 2024 Mar 16;23:100389. doi: 10.1016/j.lansea.2024.100389. eCollection 2024 Apr.
Multiplex lateral flow rapid diagnostic tests (LF-RDTs) may aid management of patients with acute non-malarial febrile illness (NMFI) in rural south and southeast Asia. We aimed to evaluate the cost-effectiveness in Cambodia and Bangladesh of a putative, as-yet-undeveloped LF-RDT capable of diagnosing enteric fever and dengue, as well as measuring C-reactive protein (CRP) to guide antibiotic prescription, in primary care patients with acute NMFI.
A country-specific decision tree model-based cost-effectiveness analysis was conducted from a health system plus limited societal perspective considering the cost of antimicrobial resistance. Parameters were based on data from a large observational study on the regional epidemiology of acute febrile illness, published studies, and procurement price lists. Costs were expressed in US$ (value in 2022), and cost-effectiveness evaluated by comparing incremental cost-effectiveness ratios with conservative opportunity cost-based willingness-to-pay thresholds and the more widely used threshold of per capita gross domestic product (GDP).
Compared to standard of care, LF-RDT-augmented clinical assessment was dominant in Cambodia, being more effective and cost-saving. The cost per disability-adjusted life year (DALY) averted in Bangladesh was US$482, slightly above the conservative opportunity cost-based willingness-to-pay threshold of US$388 and considerably lower than the GDP-based threshold of US$2687. The intervention remained dominant in Cambodia and well below the GDP-based threshold in Bangladesh when antimicrobial resistance costs were disregarded.
These findings provide guidance for academic, industry, and policymaker stakeholders involved in acute NMFI diagnostics. While definitive conclusions cannot be made in the absence of established thresholds, our results suggest that similar results are highly likely in some target settings and possible in others.
Wellcome Trust, UK Government, Royal Australasian College of Physicians, and Rotary Foundation.
多重侧向流动快速诊断检测（LF-RDT）可能有助于南亚和东南亚农村地区急性非疟疾发热性疾病（NMFI）患者的管理。我们旨在评估一种尚未开发的假定LF-RDT在柬埔寨和孟加拉国的成本效益，该检测能够诊断肠热病和登革热，并测量C反应蛋白（CRP）以指导初级保健中急性NMFI患者的抗生素处方。
从卫生系统加有限的社会视角进行基于特定国家决策树模型的成本效益分析，同时考虑抗菌药物耐药性的成本。参数基于一项关于急性发热性疾病区域流行病学的大型观察性研究、已发表的研究以及采购价格清单的数据。成本以美元（2022年价值）表示，并通过将增量成本效益比与基于保守机会成本的支付意愿阈值以及更广泛使用的人均国内生产总值（GDP）阈值进行比较来评估成本效益。
与标准治疗相比，LF-RDT增强的临床评估在柬埔寨占主导地位，更有效且节省成本。在孟加拉国，每避免一个伤残调整生命年（DALY）的成本为482美元，略高于基于保守机会成本的支付意愿阈值388美元，且远低于基于GDP的阈值2687美元。当不考虑抗菌药物耐药性成本时，该干预措施在柬埔寨仍占主导地位，在孟加拉国远低于基于GDP的阈值。
这些发现为参与急性NMFI诊断的学术、行业和政策制定利益相关者提供了指导。虽然在没有既定阈值的情况下无法得出明确结论，但我们的结果表明，在某些目标环境中很可能会有类似结果，在其他环境中也有可能。
英国惠康信托基金会、英国政府、澳大利亚皇家内科医师学院和扶轮基金会。
