Cost-effectiveness of measles rapid diagnostic tests for replacing or expanding laboratory testing in Ethiopia
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Background
In low- and middle-income countries, laboratory testing to rapidly detect measles outbreaks is limited by infrastructure availability and high costs. This study estimates the potential impact and cost-effectiveness of measles rapid diagnostic tests (RDTs) if implemented nationally in Ethiopia to either replace or expand current testing.
Methods
An agent-based model to simulate measles outbreaks was calibrated to Ethiopian measles surveillance data. Modelled outbreak outcomes were aggregated over a 10-year period. Scenarios included using RDTs to (1) replace laboratory testing; (2) replace epidemiological linkage; and (3) increase case detection, in addition to replacing laboratory testing and epidemiological linkage. Testing and outbreak response costs (in 2025 US$) were obtained from Ethiopian Public Health Institute from a government perspective. Total costs and disability-adjusted life years (DALYs) for each scenario were compared to baseline.
Results
All scenarios were cost saving compared to baseline. Replacing laboratory testing with RDTs saved US$4.2M (3.2M-4.9M) over 10-years, but due to very low testing rates the benefits of eliminating laboratory testing delays were offset by missed cases from the lower RDT sensitivity, leading to similar outbreak detection times and DALYs. Replacing epidemiological linkage with RDTs had similar DALYs but increased the cost savings to US$9.7M. Using RDTs to double case detection reduced outbreak detection time from 113 to 80 days, averted 17,000 DALYs, and saved US$4.3M.
Conclusions
In Ethiopia, use of measles RDTs could be cost saving, and if used to expand testing could prevent measles infections through faster outbreak detection and response.
Key messages
What is already known on this topic
Laboratory testing is the main surveillance tool for detection of measles outbreaks, but in low- and middle-income countries it is relatively expensive and there can be long delays in getting results due to logistic and capacity constraints in some locations.
What this study adds
Rapid diagnostic tests (RDTs) for measles have been developed to lower testing costs and reduce measles outbreak response times. This analysis used an agent-based model to simulate measles outbreaks in Ethiopian woredas and assess the cost-effectiveness of introducing RDTs for enhanced measles surveillance.
How this study might affect research, practice or policy
The findings of this study provide evidence that deploying measles RDTs in low- and middle-income countries such as Ethiopia where laboratory testing capacity is limited could be cost-saving and reduce disease burden.
