title: Cost-effectiveness of algorithms for confirmation test of human African trypanosomiasis.
abstract: The control of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) is compromised by low sensitivity of the routinely used parasitologic confirmation tests. More sensitive alternatives, such as mini-anion exchange centrifugation technique (mAECT) or capillary tube centrifugation (CTC), are more expensive. We used formal decision analysis to assess the cost-effectiveness of alternative HAT confirmation algorithms in terms of cost per life saved. The effectiveness of the standard method, a combination of lymph node puncture (LNP), fresh blood examination (FBE), and thick blood film (TBF), was 36.8%; the LNP-FBE-CTC-mAECT sequence reached almost 80%. The cost per person examined ranged from euro1.56 for LNP-FBE-TBF to euro2.99 for LNP-TBF-CTC-mAECT-CATT (card agglutination test for trypanosomiasis) titration. LNP-TBF-CTC-mAECT was the most cost-effective in terms of cost per life saved. HAT confirmation algorithms that incorporate concentration techniques are more effective and efficient than the algorithms that are currently and routinely used by several T.b. gambiense control programs.
authors.affiliation: Programmed National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of Congo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lutumba
authors.forename: Filip
authors.initials: F
authors.lastname: Meheus
authors.forename: Jo
authors.initials: J
authors.lastname: Robays
authors.forename: Constantin
authors.initials: C
authors.lastname: Miaka
authors.forename: Victor
authors.initials: V
authors.lastname: Kande
authors.forename: Philippe
authors.initials: P
authors.lastname: Büscher
authors.forename: Bruno
authors.initials: B
authors.lastname: Dujardin
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D010274:Parasitology / Q000379:methods*; D014353:Trypanosomiasis, African / Q000097:blood / Q000175:diagnosis*