Transactions of the Royal Society of Tropical Medicine and Hygiene · 2016
Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil.
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Machado de Assis Tália S, Azeredo-da-Silva André Luis Ferreira, Werneck Guilherme Loureiro, Rabello Ana
Аннотация
BACKGROUND: The objective of study was to estimate the incremental cost-effectiveness ratio (ICER) of diagnostic options for visceral leishmaniasis (VL) in Brazil.
METHODS: Six diagnostic tests were considered: IT LEISH, Kalazar Detect, DAT-LPC (DAT made in the Laboratório de Pesquisas Clínicas), IFAT, PCR and direct examination of bone marrow aspirate performed in either an ambulatory or a hospital setting. A database was built using the cost and effectiveness. The perspective of this study was the Brazilian public healthcare system and the results were expressed in costs per correctly diagnosed cases.
RESULTS: In a favorable hypothetical scenario, DAT-LPC presented the lowest cost (US$4.92) and highest effectiveness (99%). Paired analyses showed that IT LEISH was dominant compared to IFAT, microscopy and Kalazar Detect and that Kalazar Detect was dominant over IFAT and microscopy. PCR was dominant over the bone marrow aspirate in the hospital and showed an ICER of 57.76 compared with aspirate in an ambulatory setting.
CONCLUSIONS: These results highlight the need for the revision of algorithm for VL diagnostic in Brazil. Replacements of IFAT with DAT-LPC, Kalazar Detect with IT LEISH and bone marrow aspirate performed in a hospital setting with PCR are cost-effective public health measures.
METHODS: Six diagnostic tests were considered: IT LEISH, Kalazar Detect, DAT-LPC (DAT made in the Laboratório de Pesquisas Clínicas), IFAT, PCR and direct examination of bone marrow aspirate performed in either an ambulatory or a hospital setting. A database was built using the cost and effectiveness. The perspective of this study was the Brazilian public healthcare system and the results were expressed in costs per correctly diagnosed cases.
RESULTS: In a favorable hypothetical scenario, DAT-LPC presented the lowest cost (US$4.92) and highest effectiveness (99%). Paired analyses showed that IT LEISH was dominant compared to IFAT, microscopy and Kalazar Detect and that Kalazar Detect was dominant over IFAT and microscopy. PCR was dominant over the bone marrow aspirate in the hospital and showed an ICER of 57.76 compared with aspirate in an ambulatory setting.
CONCLUSIONS: These results highlight the need for the revision of algorithm for VL diagnostic in Brazil. Replacements of IFAT with DAT-LPC, Kalazar Detect with IT LEISH and bone marrow aspirate performed in a hospital setting with PCR are cost-effective public health measures.