Modelling the impact and cost-effectiveness of biomarker tests as compared with pathogen-specific diagnostics in the management of undifferentiated fever in remote tropical settingsReport as inadecuate




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Reference: Lubell, Y, Althaus, T, Blacksell, SD et al., (2016). Modelling the impact and cost-effectiveness of biomarker tests as compared with pathogen-specific diagnostics in the management of undifferentiated fever in remote tropical settings. PLoS One, 11 (3), Article: e0152420.Citable link to this page:

 

Modelling the impact and cost-effectiveness of biomarker tests as compared with pathogen-specific diagnostics in the management of undifferentiated fever in remote tropical settings

Abstract: Background:Malaria accounts for a small fraction of febrile cases in increasingly large areas of the malaria endemic world. Point-of-care tests to improve the management of non-malarial fevers appropriate for primary care are few, consisting of either diagnostic tests for specific pathogens or testing for biomarkers of host response that indicate whether antibiotics might be required. The impact and cost-effectiveness of these approaches are relatively unexplored and methods to do so are not well-developed.Methods:We model the ability of dengue and scrub typhus rapid tests to inform antibiotic treatment, as compared with testing for elevated C-Reactive Protein (CRP), a biomarker of host-inflammation. Using data on causes of fever in rural Laos, we estimate the proportion of outpatients that would be correctly classified as requiring an antibiotic and the likely cost-effectiveness of the approaches.Results:Use of either pathogen-specific test slightly increased the proportion of patients correctly classified as requiring antibiotics. CRP testing was consistently superior to the pathogen-specific tests, despite heterogeneity in causes of fever. All testing strategies are likely to result in higher average costs, but only the scrub typhus and CRP tests are likely to be cost-effective when considering direct health benefits, with median cost per disability adjusted life year averted of approximately $48 USD and $94 USD, respectively.Conclusions:Testing for viral infections is unlikely to be cost-effective when considering only direct health benefits to patients. Testing for prevalent bacterial pathogens can be cost-effective, having the benefit of informing not only whether treatment is required, but also as to the most appropriate antibiotic; this advantage, however, varies widely in response to heterogeneity in causes of fever. Testing for biomarkers of host inflammation is likely to be consistently cost-effective despite high heterogeneity, and can also offer substantial reductions in over-use of antimicrobials in viral infections.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Wellcome Trust   Notes:Copyright © 2016 Lubell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Bibliographic Details

Publisher: Public Library of Science

Publisher Website: http://www.plos.org/

Journal: PLoS Onesee more from them

Publication Website: http://journals.plos.org/plosone/

Issue Date: 2016

pages:Article: e0152420Identifiers

Urn: uuid:fd1a1cee-3a13-4de4-9867-12d23aebee8b

Source identifier: 611357

Doi: https://doi.org/10.1371/journal.pone.0152420

Issn: 1932-6203 Item Description

Type: Journal article;

Version: Publisher's version Tiny URL: pubs:611357

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Author: Lubell, Y - institutionUniversity of Oxford Oxford, MSD, NDM, Tropical Medicine, Thailand-Laos MOP grantNumberGlobal Health award

Source: https://ora.ox.ac.uk/objects/uuid:fd1a1cee-3a13-4de4-9867-12d23aebee8b



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