article · PLoS ONE
Rapid diagnostic tests, such as the SD BIOLINE HAT RDT, offer an alternative to the traditional card agglutination test for trypanosomiasis (CATT) for screening human African trypanosomiasis in the Democratic Republic of the Congo. Although the rapid test exhibits lower specificity, it provides higher sensitivity than CATT. A comparative cost-effectiveness evaluation assessed diagnostic algorithms across mobile screening teams and fixed health centres, measuring the average cost per diagnosed case. Algorithms pairing the rapid diagnostic test with parasitological confirmation proved substantially more cost-effective than CATT-based approaches. Implementing the rapid test reduced costs per diagnosed case by 33.2 percent in mobile settings and 32.92 percent in fixed facilities. Furthermore, the rapid test detected more cases across all realistic scenarios. These findings remained robust across varying facility sizes and disease prevalence levels, identifying the rapid test as a cost-effective option for routine screening.
Human African trypanosomiasis requires efficient and affordable screening tools to ensure cases are identified accurately in resource-constrained health systems. Demonstrating that rapid diagnostic tests lower the cost per diagnosed case while detecting more infections allows health programmes in the Democratic Republic of the Congo to allocate limited budgets effectively and improve routine disease surveillance across both mobile teams and fixed clinics.
The findings directly inform health authorities, diagnostic procurers, and public health programmes seeking cost-effective screening strategies for disease surveillance. Because the SD BIOLINE HAT RDT is an existing commercial diagnostic tool already tested within operational algorithms across clinics and mobile teams, this represents an applied and tested intervention suitable for immediate adoption in routine screening programmes across the Democratic Republic of the Congo.
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New rapid diagnostic tests (RDTs) for screening human African trypanosomiasis (HAT) have been introduced as alternatives to the card agglutination test for trypanosomiasis (CATT). One brand of RDT, the SD BIOLINE HAT RDT has been shown to have lower specificity but higher sensitivity than CATT, so to make a rational choice between screening strategies, a cost-effectiveness analysis is a key element. In this paper we estimate the relative cost-effectiveness of CATT and the RDT when implemented in the Democratic Republic of the Congo (DRC). Data on the epidemiological parameters and costs were collected as part of a larger study. These data were used to model three different diagnostic algorithms in mobile teams and fixed health facilities, and the relative cost-effectiveness was measured as the average cost per case diagnosed. In both fixed facilities and mobile teams, screening of participants using the SD BIOLINE HAT RDT followed by parasitological confirmation had a lower cost-effectiveness ratio than in algorithms using CATT. Algorithms using the RDT were cheaper by 112.54 (33.2%) and 88.54 (32.92%) US dollars per case diagnosed in mobile teams and fixed health facilities respectively, when compared with algorithms using CATT. Sensitivity analysis demonstrated that these conclusions were robust to a number of assumptions, and that the results can be scaled to smaller or larger facilities, and a range of prevalences. The RDT was the most cost-effective screening test in all realistic scenarios and detected more cases than CATT. Thus, on this basis, the SD BIOLINE HAT RDT could be considered as the most cost-effective option for use in routine screening for HAT in the DRC.
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DOI: 10.1371/journal.pone.0204335
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