Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals

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cg.authorship.typesCGIAR and developing country instituteen
cg.authorship.typesCGIAR and advanced research instituteen
cg.contributor.affiliationInternational Livestock Research Instituteen
cg.contributor.affiliationUniversity of Liverpoolen
cg.contributor.affiliationKenya Medical Research Instituteen
cg.contributor.affiliationUniversidad de Navarraen
cg.contributor.crpAgriculture for Nutrition and Health
cg.contributor.donorBiotechnology and Biological Sciences Research Council, United Kingdomen
cg.contributor.donorEconomic and Social Research Council, United Kingdomen
cg.contributor.donorMedical Research Council, United Kingdomen
cg.contributor.donorNatural Environment Research Council, United Kingdomen
cg.contributor.donorGovernment of the United Kingdomen
cg.contributor.donorDefence Science and Technology Laboratory, United Kingdomen
cg.contributor.donorWellcome Trusten
cg.contributor.donorSoulsby Foundationen
cg.contributor.donorMinistry of Economy and Competitiveness, Spainen
cg.contributor.donorInstitute for Tropical Health funders, Spainen
cg.coverage.countryKenya
cg.coverage.iso3166-alpha2KE
cg.coverage.regionAfrica
cg.coverage.regionEastern Africa
cg.creator.identifierLorren Alumasa: 0000-0002-1723-0510en
cg.creator.identifierLian Thomas: 0000-0001-8447-1210en
cg.creator.identifierSamuel Njoroge: 0000-0001-6965-3681en
cg.creator.identifierJOSIAH MAKHANDIA: 0000-0001-6005-704Xen
cg.creator.identifierEric M. Fèvre: 0000-0001-8931-4986en
cg.creator.identifierLaura Cristina Falzon: 0000-0002-4043-1644en
cg.creator.identifierJonathan Rushton: 0000-0001-5450-4202en
cg.howPublishedFormally Publisheden
cg.identifier.doihttps://doi.org/10.1371/journal.pntd.0008977en
cg.isijournalISI Journalen
cg.issn1935-2735en
cg.issue1en
cg.journalPLOS Neglected Tropical Diseasesen
cg.reviewStatusPeer Reviewen
cg.subject.ilriBRUCELLOSISen
cg.subject.ilriDIAGNOSTICSen
cg.subject.ilriHUMAN HEALTHen
cg.subject.ilriZOONOTIC DISEASESen
cg.subject.impactAreaNutrition, health and food security
cg.subject.sdgSDG 3 - Good health and well-beingen
cg.volume15en
dc.contributor.authorAlumasa, Lorrenen
dc.contributor.authorThomas, Lian F.en
dc.contributor.authorAmanya, Fredricken
dc.contributor.authorNjoroge, Samuel M.en
dc.contributor.authorMoriyón, I.en
dc.contributor.authorMakhandia, Josiahen
dc.contributor.authorRushton, Jonathanen
dc.contributor.authorFèvre, Eric M.en
dc.contributor.authorFalzon, Laura C.en
dc.date.accessioned2021-01-09T16:07:16Zen
dc.date.available2021-01-09T16:07:16Zen
dc.identifier.urihttps://hdl.handle.net/10568/110774
dc.titleHospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitalsen
dcterms.abstractHospitals 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.en
dcterms.accessRightsOpen Access
dcterms.audienceScientistsen
dcterms.available2021-01-07en
dcterms.bibliographicCitationAlumasa, L., Thomas, L.F., Amanya, F., Njoroge, S.M., Moriyón, I., Makhandia, J., Rushton, J., Fèvre, E.M. and Falzon, L.C. 2021. Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals. PLOS Neglected Tropical Diseases 15(1): e0008977.en
dcterms.issued2021-01-07en
dcterms.languageen
dcterms.licenseCC-BY-4.0
dcterms.publisherPublic Library of Scienceen
dcterms.subjectbrucellosisen
dcterms.subjectdiagnosisen
dcterms.subjectzoonosesen
dcterms.subjecthealthen
dcterms.typeJournal Article

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