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

Abstract

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.

Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania

“…All the FBAT kits identified in this study were purchased through private suppliers and distributors of reagents. Commercial procurement of reagents through decentralized sources leads to variation in price and availability of reagents for brucellosis testing also observed in this study ( S1 Table ) [ 22 , 43 , 44 ].…”

“…A previous study among high-risk abattoir workers in Tanga Region using the Rose Bengal Test reported a prevalence of up to 19.5% [ 47 ]. This mean 21% reported in Arusha Region over the seven-year study period is slightly higher than the focused abattoir workers’ study, probably due to the higher test positivity reported with most FBAT kits in Arusha health facilities compared to the Rose Bengal Test used in the Tanga study [ 18 , 22 ]. The higher prevalence observed in this dataset as compared to that recorded with the RBT in the targeted, high-risk group prevalence reported among slaughterhouse workers does not seem epidemiologically plausible.…”

“…Instead, studies conducted in Tanzania and the East Africa region have identified a range of rapid, febrile Brucella agglutination tests (FBAT) that are used in health facilities to test for brucellosis [ 18 – 21 ]. None of these rapid tests are recommended for brucellosis diagnosis in any national or international guidelines and several studies to date have indicated poor performance of these rapid tests [ 18 , 21 , 22 ].…”

Identifying potential natural inhibitors of Brucella melitensis Methionyl-tRNA synthetase through an in-silico approach

“…In livestock production, the major economic effects are due to abortion, premature birth, reduced milk production, repeat breeding and cost of veterinary care [ 14 ]. In humans, the disease results in loss of manpower as well as huge costs in medical care [ 15 ]. Thus, the control of the disease in most developed countries has resulted in significant economic gains as well as reduction in human cases.…”

Using a One Health Case-Based Investigation for Improved Control of Brucellosis in Isiolo, Kenya

“…The many available tests for Brucella serology have moreover led to inconsistencies and confusion, allowing the introduction and distribution of highly unreliable tests, such as the Febrile Brucella Agglutination Test (FBAT) (23). Despite its proven inadequacy and cost-inefficiency due to misdiagnoses, FBAT is continuously being used in Kenya (24). This illustrates the challenge of evidential data reaching the destination of benefit, and additional scrutiny is needed to understand the distribution and establishment of these tests.…”