Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis.
BACKGROUND
Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients.


METHODS
The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1) no patients tested or given antibiotic treatment; 2) all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3) lateral flow; 4) MCAT; 5) latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs.


RESULTS
Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment.


CONCLUSIONS
Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be the most efficient strategy.
Suputtamongkol
Yupin
Y
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. siysp@mahidol.ac.th
Pongtavornpinyo
Wirichada
W
Lubell
Yoel
Y
Suttinont
Chuanpit
C
Hoontrakul
Siriwan
S
Phimda
Kriangsak
K
Losuwanaluk
Kitti
K
Suwancharoen
Duangjai
D
Silpasakorn
Saowaluk
S
Chierakul
Wirongrong
W
Day
Nick
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019090:Case Management / Q000191:economics*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004318:Doxycycline