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_US
cg.authorship.typesCGIAR and advanced research instituteen_US
cg.contributor.affiliationInternational Livestock Research Instituteen_US
cg.contributor.affiliationUniversity of Liverpoolen_US
cg.contributor.affiliationKenya Medical Research Instituteen_US
cg.contributor.affiliationUniversidad de Navarraen_US
cg.contributor.crpAgriculture for Nutrition and Healthen_US
cg.contributor.donorBiotechnology and Biological Sciences Research Council, United Kingdomen_US
cg.contributor.donorEconomic and Social Research Council, United Kingdomen_US
cg.contributor.donorMedical Research Council, United Kingdomen_US
cg.contributor.donorNatural Environment Research Council, United Kingdomen_US
cg.contributor.donorGovernment of the United Kingdomen_US
cg.contributor.donorDefence Science and Technology Laboratory, United Kingdomen_US
cg.contributor.donorWellcome Trusten_US
cg.contributor.donorSoulsby Foundationen_US
cg.contributor.donorMinistry of Economy and Competitiveness, Spainen_US
cg.contributor.donorInstitute for Tropical Health funders, Spainen_US
cg.coverage.countryKenyaen_US
cg.coverage.iso3166-alpha2KEen_US
cg.coverage.regionAfricaen_US
cg.coverage.regionEastern Africaen_US
cg.creator.identifierLorren Alumasa: 0000-0002-1723-0510en_US
cg.creator.identifierLian Thomas: 0000-0001-8447-1210en_US
cg.creator.identifierSamuel Njoroge: 0000-0001-6965-3681en_US
cg.creator.identifierJOSIAH MAKHANDIA: 0000-0001-6005-704Xen_US
cg.creator.identifierEric M. Fèvre: 0000-0001-8931-4986en_US
cg.creator.identifierLaura Cristina Falzon: 0000-0002-4043-1644en_US
cg.creator.identifierJonathan Rushton: 0000-0001-5450-4202en_US
cg.howPublishedFormally Publisheden_US
cg.identifier.doihttps://doi.org/10.1371/journal.pntd.0008977en_US
cg.isijournalISI Journalen_US
cg.issn1935-2735en_US
cg.issue1en_US
cg.journalPLOS Neglected Tropical Diseasesen_US
cg.reviewStatusPeer Reviewen_US
cg.subject.ilriBRUCELLOSISen_US
cg.subject.ilriDIAGNOSTICSen_US
cg.subject.ilriHUMAN HEALTHen_US
cg.subject.ilriZOONOTIC DISEASESen_US
cg.subject.impactAreaNutrition, health and food securityen_US
cg.subject.sdgSDG 3 - Good health and well-beingen_US
cg.volume15en_US
dc.contributor.authorAlumasa, Lorrenen_US
dc.contributor.authorThomas, Lian F.en_US
dc.contributor.authorAmanya, Fredricken_US
dc.contributor.authorNjoroge, Samuel M.en_US
dc.contributor.authorMoriyón, I.en_US
dc.contributor.authorMakhandia, Josiahen_US
dc.contributor.authorRushton, Jonathanen_US
dc.contributor.authorFèvre, Eric M.en_US
dc.contributor.authorFalzon, Laura C.en_US
dc.date.accessioned2021-01-09T16:07:16Zen_US
dc.date.available2021-01-09T16:07:16Zen_US
dc.identifier.urihttps://hdl.handle.net/10568/110774en_US
dc.titleHospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitalsen_US
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_US
dcterms.accessRightsOpen Accessen_US
dcterms.audienceScientistsen_US
dcterms.available2021-01-07en_US
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_US
dcterms.issued2021-01-07en_US
dcterms.languageenen_US
dcterms.licenseCC-BY-4.0en_US
dcterms.publisherPublic Library of Scienceen_US
dcterms.subjectbrucellosisen_US
dcterms.subjectdiagnosisen_US
dcterms.subjectzoonosesen_US
dcterms.subjecthealthen_US
dcterms.typeJournal Articleen_US

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