Manca Francesco, Ciminata Giorgio, Grieve Eleanor, Reboud Julien, Cooper Jonathan, McIntosh Emma
School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom.
PLoS Negl Trop Dis. 2024 Jul 29;18(7):e0012339. doi: 10.1371/journal.pntd.0012339. eCollection 2024 Jul.
In countries where malaria is endemic, the use of rapid diagnostic tests(RDTs) has become routine, especially in rural settings. Such regions are characterised by often having other co-endemic infectious diseases, at high levels of prevalence.
To illustrate the potential added-value of "sentinel" screening for patients presenting for a routine diagnostic test for malaria, at healthcare facilities in Uganda.
We developed an economic model by combining two decision trees, one for malaria and a second for the co-endemic disease schistosomiasis. The integrated model was designed to inform policy strategies for the co-endemic disease in addition to malaria (i.e., whether to test opportunistically for schistosomiasis or use mass drug administration(MDA) as per usual practice).We performed the analysis on three comparators varying testing accuracy and costs.
Sentinel screening can provide added value to the testing of patients compared with the status quo: when schistosomiasis prevalence is high then MDA is preferential; if low prevalence, treating no one is preferred. If the disease has average levels of prevalence, then a strategy involving testing is preferred. Prevalence thresholds driving the dominant strategy are dependent upon the model parameters, which are highly context specific. At average levels of prevalence for schistosomiasis and malaria for Uganda, adding a sentinel screening was cost-effective when the accuracy of test was higher than current diagnostics and when economies of scope were generated(Expected value clinical Information = 0.65$ per DALY averted, 137.91$ per correct diagnoses).Protocols using diagnostics with current accuracy levels were preferred only for levels of MDA coverage below 75%.
The importance of the epidemiological setting is crucial in determining the best cost-effective strategy for detecting endemic disease. Economies of scope can make sentinel screenings cost-effective strategies in specific contexts. Blanket thresholds recommended for MDA may not always be the preferred option for endemic diseases.
在疟疾流行的国家，快速诊断检测（RDTs）的使用已成为常规操作，尤其是在农村地区。这些地区的特点是往往还存在其他共同流行的传染病，且患病率很高。
说明在乌干达的医疗机构中，对进行疟疾常规诊断检测的患者进行“哨兵”筛查的潜在附加价值。
我们通过结合两个决策树开发了一个经济模型，一个用于疟疾，另一个用于共同流行的疾病血吸虫病。该综合模型旨在为除疟疾外的共同流行疾病（即是否按常规做法对血吸虫病进行机会性检测或使用大规模药物治疗（MDA））提供政策策略依据。我们对三种不同检测准确性和成本的比较方案进行了分析。
与现状相比，哨兵筛查可为患者检测提供附加价值：当血吸虫病患病率高时，MDA是首选；如果患病率低，则不治疗是首选。如果疾病患病率处于平均水平，那么涉及检测的策略是首选。驱动主导策略的患病率阈值取决于模型参数，这些参数具有高度的背景特异性。在乌干达血吸虫病和疟疾的平均患病率水平下，当检测准确性高于当前诊断且产生范围经济时，增加哨兵筛查具有成本效益（每避免一个伤残调整生命年的预期临床信息价值为0.65美元，每正确诊断一次为137.91美元）。仅当MDA覆盖率低于75%时，使用当前准确性水平诊断的方案才是首选。
流行病学背景对于确定检测地方病的最佳成本效益策略至关重要。范围经济可使哨兵筛查在特定情况下成为具有成本效益的策略。推荐的MDA统一阈值可能并不总是地方病的首选方案。
