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Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals.
Alumasa, Lorren; Thomas, Lian F; Amanya, Fredrick; Njoroge, Samuel M; Moriyón, Ignacio; Makhandia, Josiah; Rushton, Jonathan; Fèvre, Eric M; Falzon, Laura C.
Afiliação
  • Alumasa L; International Livestock Research Institute, Nairobi, Kenya.
  • Thomas LF; International Livestock Research Institute, Nairobi, Kenya.
  • Amanya F; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Njoroge SM; International Livestock Research Institute, Nairobi, Kenya.
  • Moriyón I; International Livestock Research Institute, Nairobi, Kenya.
  • Makhandia J; Kenya Medical Research Institute, Nairobi, Kenya.
  • Rushton J; Departamento de Microbiología y Parasitología, Facultad de Medicina, and Institute for Tropical Health, Universidad de Navarra, Pamplona, Spain.
  • Fèvre EM; International Livestock Research Institute, Nairobi, Kenya.
  • Falzon LC; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
PLoS Negl Trop Dis ; 15(1): e0008977, 2021 01.
Article em En | MEDLINE | ID: mdl-33411798
Hospitals in Kenya continue to use the Febrile Antigen Brucella Agglutination Test (FBAT) to diagnose brucellosis, despite reports showing its inadequacy. This study generated hospital-based evidence on the performance and cost-effectiveness of the FBAT, compared to the Rose Bengal Test (RBT).Twelve hospitals in western Kenya stored patient serum samples that were tested for brucellosis using the FBAT, and these were later re-tested using the RBT. Data on the running time and cost of the FBAT, and the treatment prescribed for brucellosis, were collected. The cost-effectiveness of the two tests, defined as the cost in US Dollars ($) per Disability Adjusted Life Year (DALY) averted, was determined, and a basic sensitivity analysis was run to identify the most influential parameters. Over a 6-month period, 180 patient serum samples that were tested with FBAT at the hospitals were later re-tested with RBT at the field laboratory. Of these 24 (13.3%) and 3 (1.7%) tested positive with FBAT and RBT, respectively. The agreement between the FBAT and RBT was slight (Kappa = 0.12). Treatment prescribed following FBAT positivity varied between hospitals, and only one hospital prescribed a standardized therapy regimen. The mean $/DALY averted when using the FBAT and RBT were $2,065 (95% CI $481-$6,736) and $304 (95% CI $126-$604), respectively. Brucellosis prevalence was the most influential parameter in the cost-effectiveness of both tests. Extrapolation to the national level suggested that an estimated $338,891 (95% CI $47,000-$1,149,000) per year is currently spent unnecessarily treating those falsely testing positive by FBAT. These findings highlight the potential for misdiagnosis using the FBAT. Furthermore, the RBT is cost-effective, and could be considered as the mainstay screening test for human brucellosis in this setting. Lastly, the treatment regimens must be harmonized to ensure the appropriate use of antibiotics for treatment.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Brucelose / Testes de Aglutinação Tipo de estudo: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: PLoS Negl Trop Dis Assunto da revista: MEDICINA TROPICAL Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Quênia

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Brucelose / Testes de Aglutinação Tipo de estudo: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: PLoS Negl Trop Dis Assunto da revista: MEDICINA TROPICAL Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Quênia