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

PLoS One. 2018 Sep 21;13(9):e0204335. doi: 10.1371/journal.pone.0204335. eCollection 2018.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Agglutination Tests / economics*
  • Algorithms
  • Cost-Benefit Analysis*
  • Democratic Republic of the Congo / epidemiology
  • Diagnostic Tests, Routine / economics
  • Humans
  • Sensitivity and Specificity
  • Trypanosomiasis, African / diagnosis*
  • Trypanosomiasis, African / epidemiology

Grants and funding

This work was supported by the Bill & Melinda Gates Foundation and the UK aid from the UK government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Epi Interventions Ltd. provided support in the form of salaries for author PRB, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.