Performance and cost-effectiveness of immunochromatography based rapid diagnostic test (RDT) kits in diagnosis of dengue infection in resource limited set up

Abstract

Background: Dengue infection occurs among more than 50 million annually. In India, the case fatality rate is up to 3-5%. Early diagnosis is crucial to the clinical care. However the currently recommended diagnostic tests by WHO is costly, time consuming, labor and technologically demanding which may not be available in the resource limited set up where the large burden of dengue related illness occur.This study evaluated the role of immunochromatographic method based rapid diagnostic test kits (RDT) and costeffectiveness for the diagnosis of acute dengue infection.Methods & Materials: 281 adult patients presenting to Christian Medical College, Vellore, India with community acquired acute febrile illness between September 2012 to February 2013 were recruited for the study. The patients with other proven etiology were used as negative control. 132 cases of dengue and 149 cases of non-dengue infection were enrolled. The RDTs tested from 4 manufacturers were Panbio, SD, J.Mitra and Reckon. SPSS version 16.0.1 was used for statistical analysis.Results: Performance of the RDTs based on IgM: The sensitivity, specificity, PPV and NPV of Panbio, SD, Reckon and J.Mitra. The inter-rater kappa agreement between Panbio with SD duo of 0.54 was found to be moderate. Performance of the RDTs based on NS1 detection:The sensitivity, specificity, PPV and NPV of the SD, Reckon, and J.Mitra. The inter-rater kappa agreement between SD with Reckon of 0.79 was found to be best and substantial.Combination of RDTs: the best sensitivity of 99.2% was achieved by testing Panbio and SD in parallel. The best specificity of 99.9% and 100% respectively was obtained when Reckon with Panbio or SD was performed in series.None of the RDTs could not adequately differentiate between acute primary and secondary dengue. Conclusion:In the region of high dengue endemicity, Panbio RDT alone is highly sensitive, cost effective (∼13.6 USD), easier to perform and shorter turnover time makes it a test of choice in resource limited set up during an outbreak season.

Rapid immunochromatographic tests for the diagnosis of dengue: a systematic review and meta-analysis

“…A recent systematic review 12 on the economic impact of dengue's ICT favored a relatively obsolete diagnostic strategy based on IgM Panbio for acute cases. However, it identified only two studies, one using primary observational data 14 and the other, a simulation modeling design 15 .…”

A systematic review of the economic impact of rapid diagnostic tests for dengue

“…Also, the reporting Checklist for Cost-effectiveness Analyses from Second Panel on Cost-Effectiveness in Health and Medicine (Additional file 1 : Table S1) [ 48 , 49 ]. In addition, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed [ 48 , 50 ]. This review is registered in the PROSPERO international prospective register of systematic reviews, under the title “Systematic review of health economic assessments of dengue rapid diagnostic tests” (registry number: CRD42015017775).…”

Mobile Application for Dengue Fever Monitoring and Tracking via GPS: Case Study for Fiji

“…However, during the early infection period, when symptoms may not be as severe as later in the course, the patient with dengue fever can appear to have a less serious illness and therefore may not be given appropriate treatment [19]. The early recognition of dengue symptom is very important, however, dengue detection kits are only accessible in hospitals because of the high costs [21]. Therefore, a more convenient method of diagnosing dengue in patients is needed.…”