Cost-effectiveness of using a rapid diagnostic test to screen for human African trypanosomiasis in the Democratic Republic of the Congo

Abstract

New rapid diagnostic tests (RDTs) for screening human African trypanosomiasis (HAT) have been introduced as alternatives to the card agglutination test for trypanosomiasis (CATT). One brand of RDT, the SD BIOLINE HAT RDT has been shown to have lower specificity but higher sensitivity than CATT, so to make a rational choice between screening strategies, a cost-effectiveness analysis is a key element. In this paper we estimate the relative cost-effectiveness of CATT and the RDT when implemented in the Democratic Republic of the Congo (DRC). Data on the epidemiological parameters and costs were collected as part of a larger study. These data were used to model three different diagnostic algorithms in mobile teams and fixed health facilities, and the relative cost-effectiveness was measured as the average cost per case diagnosed. In both fixed facilities and mobile teams, screening of participants using the SD BIOLINE HAT RDT followed by parasitological confirmation had a lower cost-effectiveness ratio than in algorithms using CATT. Algorithms using the RDT were cheaper by 112.54 (33.2%) and 88.54 (32.92%) US dollars per case diagnosed in mobile teams and fixed health facilities respectively, when compared with algorithms using CATT. Sensitivity analysis demonstrated that these conclusions were robust to a number of assumptions, and that the results can be scaled to smaller or larger facilities, and a range of prevalences. The RDT was the most cost-effective screening test in all realistic scenarios and detected more cases than CATT. Thus, on this basis, the SD BIOLINE HAT RDT could be considered as the most cost-effective option for use in routine screening for HAT in the DRC.

Development and implementation of a strategy for intensified screening for gambiense human African trypanosomiasis in Kongo Central province, DRC

“…In this paper, we have described the implementation of a programme that aims to intensify screening for HAT and increase early case finding, and thus expect to contribute to elimination of HAT in Kongo Central province, a well-circumscribed and well-delimited transboundary HAT focus in DRC, Angola and Republic of Congo. This is in the context of declining HAT incidence, which requires novel means of detecting the remaining cases in a cost-effective manner [ 21 ]. By utilising the existing health facility network that has been established by the country, with the aim of ensuring that the population is within 5 or 8km at the most from a health facility [ 20 ], the existing health facilities are used to improve population coverage.…”

Product Development Partnerships: Delivering Innovation for the Elimination of African Trypanosomiasis?

“…It has also carved out a role for its RDT in low areas of low endemicity (knowing the ITM test would be used in areas of high endemicity), framing its usefulness in support of elimination efforts [43]. Finally, FIND secured a lower unit price for its tests (less than US $1 per test as opposed to~US $2.50) (Interview 19 November 2013) [44], thus contributing to a narrative-that its research arm helps to perpetuate-that the SD RDT is notably cost-effective [45]. Implementation research conducted by the Diagnostic Tools for HAT Elimination and Clinical Trials project (DiTECT-HAT) has since suggested that the ITM and FIND RDTs do not even necessarily need to compete; that potentially, they can both be incorporated into algorithms for passive case detection and post-elimination monitoring [46].…”

Human African trypanosomiasis: current status and eradication efforts

“…More recently, rapid diagnostic tests (RDTs) have been available to screen for gHAT. These tests have an important role in the fixed passive detection health centres since they do not require electricity and are instrument-free [74]. This means rural hospitals that are often ill-equipped can still screen for HAT, and hence, RDTs have been widely distributed in remote endemic areas [74][75][76].…”

“…These tests have an important role in the fixed passive detection health centres since they do not require electricity and are instrument-free [74]. This means rural hospitals that are often ill-equipped can still screen for HAT, and hence, RDTs have been widely distributed in remote endemic areas [74][75][76]. While these tests are being developed to have both high sensitivity and specificity (comparable to CATT) [77][78][79][80][81][82], in areas where the infection numbers are low, the number of false positives from RDTs can far outweigh the number of true positives, resulting in a very low positive predictive value [2,83].…”

“…While these tests are being developed to have both high sensitivity and specificity (comparable to CATT) [77][78][79][80][81][82], in areas where the infection numbers are low, the number of false positives from RDTs can far outweigh the number of true positives, resulting in a very low positive predictive value [2,83]. Cost-effectiveness analysis has suggested that RDTs could be more cost-effective than CATT in both mobile and fixed health facilities [74].…”