Journal article
Cost-effectiveness analysis of a multiplex lateral flow rapid diagnostic test for acute non-malarial febrile illness in rural Cambodia and Bangladesh
- Abstract:
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Background
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.Methods
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 dollars (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).Findings
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 482 US dollars , slightly above the conservative opportunity cost-based willingness-to-pay threshold of 388 US dollars and considerably lower than the GDP-based threshold of 2687 US dollars . The intervention remained dominant in Cambodia and well below the GDP-based threshold in Bangladesh when antimicrobial resistance costs were disregarded.Interpretation
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.Funding
Wellcome Trust, UK Government, Royal Australasian College of Physicians, and Rotary Foundation.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.1MB, Terms of use)
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- Publisher copy:
- 10.1016/j.lansea.2024.100389
Authors
+ Wellcome Trust
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- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 215604/Z/19/Z
- Publisher:
- Elsevier
- Journal:
- Lancet Regional Health - Southeast Asia More from this journal
- Volume:
- 23
- Article number:
- 100389
- Place of publication:
- England
- Publication date:
- 2024-03-16
- Acceptance date:
- 2024-03-04
- DOI:
- ISSN:
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2772-3682
- Pmid:
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38523864
- Language:
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English
- Keywords:
- Pubs id:
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1878805
- Local pid:
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pubs:1878805
- Deposit date:
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2024-08-09
- ARK identifier:
Terms of use
- Copyright holder:
- Chew et al.
- Copyright date:
- 2024
- Rights statement:
- © 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
- Notes:
- This research was funded in whole or in part by the Wellcome Trust (215604/Z/19/Z). For the purposes of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript (AAM) version arising from this submission.
- Licence:
- CC Attribution (CC BY)
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