Cost-effectiveness of algorithms for confirmation test of human African trypanosomiasis.
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.
Lutumba
Pascal
P
Programmed National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of Congo.
Meheus
Filip
F
Robays
Jo
J
Miaka
Constantin
C
Kande
Victor
V
Büscher
Philippe
P
Dujardin
Bruno
B
Boelaert
Marleen
M
D000465:Algorithms; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D010274:Parasitology / Q000379:methods*; D014353:Trypanosomiasis, African / Q000097:blood / Q000175:diagnosis*