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. 2007 Oct;13(10):1484-90.
doi: 10.3201/eid1310.060358.

Cost-effectiveness of algorithms for confirmation test of human African trypanosomiasis

Pascal Lutumba  1 , Filip Meheus, Jo Robays, Constantin Miaka, Victor Kande, Philippe Büscher, Bruno Dujardin, Marleen Boelaert
Affiliations

Cost-effectiveness of algorithms for confirmation test of human African trypanosomiasis

Pascal Lutumba et al. Emerg Infect Dis. 2007 Oct.

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.

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Figures

Figure 1
Figure 1
Decision tree comparing algorithms used to analyze human African trypanosomiasis (HAT). LNP, lymph node puncture; FBE, fresh blood examination; TBF, thick blood film; CTC, capillary tube centrifugation; CATT, card agglutination test for trypanosomiasis; CATT titration, CATT titration at end-titer 8; mAECT, mini-anion-exchange centrifugation technique.
Figure 2
Figure 2
Sensitivity analysis of cost-effectiveness (€/life saved) according to variation in prevalence of human African trypanosomiasis (HAT). CTC, capillary tube centrifugation; mAECT, mini-anion-exchange centrifugation technique; CATT, card agglutination test for trypanosomiasis.
Figure 3
Figure 3
Variations in cost-effectiveness ratios as a function of prevalence of human African trypanosomiasis (HAT). LNP, lymph node puncture; FBE, fresh blood examination; TBF, thick blood film; CTC, capillary tube centrifugation; mAECT, mini-anion-exchange centrifugation technique; CATT, card agglutination test for trypanosomiasis; CATT titration, CATT titration at end-titer 8.
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