The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis.

Abstract:

OBJECTIVE:Rapid diagnostic tests for malaria seem cost effective in standard analyses, but these do not take account of clinicians' response to test results. This study tested the impact of clinicians' response to rapid diagnostic test or microscopy results on the costs and benefits of testing at different levels of malaria transmission and in different age groups. DESIGN:Cost-benefit analysis using a decision tree model and clinical data on the effectiveness of diagnostic tests for malaria, their costs, and clinicians' response to test results. SETTING:Tanzania. METHODS:Data were obtained from a clinical trial of 2425 patients carried out in three settings of varying transmission. RESULTS:At moderate and low levels of malaria transmission, rapid diagnostic tests were more cost beneficial than microscopy, and both more so than presumptive treatment, but only where response was consistent with test results. At the levels of prescription of antimalarial drugs to patients with negative tests that have been found in observational studies and trials, neither test methodis likely to be cost beneficial, incurring costs 10-250% higher, depending on transmission rate, than would have been the case with fully consistent responses to all test results. Microscopy becomes more cost beneficial than rapid diagnostic tests when its sensitivity under operational conditions approaches that of rapid diagnostic tests. CONCLUSIONS:Improving diagnostic methods, including rapid diagnostic tests, can reduce costs and enhance the benefits of effective antimalarial drugs, but only if the consistency of response to test results is also improved. Investing in methods to improve rational response to tests is essential. Economic evaluations of diagnostic tests should take into account whether clinicians' response is consistent with test results.

journal_name

BMJ

authors

Lubell Y,Reyburn H,Mbakilwa H,Mwangi R,Chonya S,Whitty CJ,Mills A

doi

10.1136/bmj.39395.696065.47

subject

Has Abstract

pub_date

2008-01-26 00:00:00

pages

202-5

issue

7637

eissn

0959-8138

issn

1756-1833

pii

bmj.39395.696065.47

journal_volume

336

pub_type

杂志文章,多中心研究,随机对照试验
  • Dogs that bite.

    abstract:OBJECTIVE:To study the circumstances of dog bites and identify risk factors. DESIGN:Postal questionnaire survey and case note review of victims of dog bites referred between 1982 and 1989. SETTING:One referral based regional plastic surgery unit. PATIENTS:146 consecutive patients referred for primary treatment of do...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.303.6816.1512

    authors: Shewell PC,Nancarrow JD

    更新日期:1991-12-14 00:00:00

  • Industry funding of patient and health consumer organisations: systematic review with meta-analysis.

    abstract:OBJECTIVE:To investigate pharmaceutical or medical device industry funding of patient groups. DESIGN:Systematic review with meta-analysis. DATA SOURCES:Ovid Medline, Embase, Web of Science, Scopus, and Google Scholar from inception to January 2018; reference lists of eligible studies and experts in the field. ELIGIB...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.l6925

    authors: Fabbri A,Parker L,Colombo C,Mosconi P,Barbara G,Frattaruolo MP,Lau E,Kroeger CM,Lunny C,Salzwedel DM,Mintzes B

    更新日期:2020-01-22 00:00:00

  • Cardiac rehabilitation for heart failure can improve quality of life and fitness.

    abstract::The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 评论,杂志文章

    doi:10.1136/bmj.l5456

    authors: Cook R,Davidson P,Martin R,NIHR Dissemination Centre.

    更新日期:2019-10-01 00:00:00

  • Using clinicopathological analysis of general practitioner skin surgery to determine educational requirements and guidelines.

    abstract:OBJECTIVE:To study the impact of skin surgery in general practice on the workload of a pathology laboratory and to identify what further training might be helpful. DESIGN:Analysis of skin biopsy specimens from general practitioners before and after their new contract to determine numbers of specimens, changes in diagn...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.304.6819.93

    authors: Cox NH,Wagstaff R,Popple AW

    更新日期:1992-01-11 00:00:00

  • Angiotensin converting enzyme insertion or deletion polymorphism and coronary restenosis: meta-analysis of 16 studies.

    abstract:OBJECTIVE:To assess the association between genotype at the insertion or deletion polymorphism of the angiotensin converting enzyme gene and risk of coronary restenosis after percutaneous coronary intervention. DESIGN:Meta-analysis of studies before July 2001 that reported on these genotypes and risk of coronary reste...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.325.7363.517

    authors: Bonnici F,Keavney B,Collins R,Danesh J

    更新日期:2002-09-07 00:00:00

  • Dental disease and risk of coronary heart disease and mortality.

    abstract:OBJECTIVE:To investigate a reported association between dental disease and risk of coronary heart disease. SETTING:National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN:Prospective cohort study in which participants underwent a standard dental examination at bas...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6879.688

    authors: DeStefano F,Anda RF,Kahn HS,Williamson DF,Russell CM

    更新日期:1993-03-13 00:00:00

  • Statin use and risk of community acquired pneumonia in older people: population based case-control study.

    abstract:OBJECTIVE:To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia. DESIGN:Population based case-control study. SETTING:Group Health, a large integrated healthcare delivery system. Population Immunocompetent, community dwelling ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.b2137

    authors: Dublin S,Jackson ML,Nelson JC,Weiss NS,Larson EB,Jackson LA

    更新日期:2009-06-16 00:00:00

  • Identifying problems with data collection at a local level: survey of NHS maternity units in England.

    abstract:OBJECTIVES:To document the extent to which maternity data are collected and how they are recorded, and to identify problems that may affect their availability throughout the NHS. METHODS:Postal survey in September 1997 with structured questionnaires. SETTING:207 NHS trusts with maternity units in England. PARTICIPAN...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.319.7210.619

    authors: Kenney N,Macfarlane A

    更新日期:1999-09-04 00:00:00

  • Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study.

    abstract:OBJECTIVE:To determine the association of resting echocardiography before elective intermediate to high risk non-cardiac surgery with survival and length of hospital stay. DESIGN:Population based retrospective cohort study. SETTING:Acute care hospitals in Ontario, Canada, between 1 April 1999 and 31 March 2008. PART...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.d3695

    authors: Wijeysundera DN,Beattie WS,Karkouti K,Neuman MD,Austin PC,Laupacis A

    更新日期:2011-06-30 00:00:00

  • Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration.

    abstract:OBJECTIVES:To investigate the effectiveness of non-benzodiazepine hypnotics (Z drugs) and associated placebo responses in adults and to evaluate potential moderators of effectiveness in a dataset used to approve these drugs. DESIGN:Systematic review and meta-analysis. DATA SOURCE:US Food and Drug Administration (FDA)...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.e8343

    authors: Huedo-Medina TB,Kirsch I,Middlemass J,Klonizakis M,Siriwardena AN

    更新日期:2012-12-17 00:00:00

  • Trial of support treatment with human chorionic gonadotrophin in the luteal phase after treatment with buserelin and human menopausal gonadotrophin in women taking part in an in vitro fertilisation programme.

    abstract:OBJECTIVE:To evaluate the effect of support with human chorionic gonadotrophin in the luteal phase in women taking part in an in vitro fertilisation programme after buserelin and human menopausal gonadotrophin were used to hyperstimulate their ovaries. DESIGN:Controlled group comparison. SETTING:Outpatient department...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章

    doi:10.1136/bmj.298.6686.1483

    authors: Smith EM,Anthony FW,Gadd SC,Masson GM

    更新日期:1989-06-03 00:00:00

  • Utility of genetic and non-genetic risk factors in prediction of type 2 diabetes: Whitehall II prospective cohort study.

    abstract:OBJECTIVES:To assess the performance of a panel of common single nucleotide polymorphisms (genotypes) associated with type 2 diabetes in distinguishing incident cases of future type 2 diabetes (discrimination), and to examine the effect of adding genetic information to previously validated non-genetic (phenotype based)...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.b4838

    authors: Talmud PJ,Hingorani AD,Cooper JA,Marmot MG,Brunner EJ,Kumari M,Kivimäki M,Humphries SE

    更新日期:2010-01-14 00:00:00

  • Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial.

    abstract:OBJECTIVE:To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa. DESIGN:Cluster randomised controlled trial over 20 weeks. SETTING:Family compou...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38512.618681.E0

    authors: Crump JA,Otieno PO,Slutsker L,Keswick BH,Rosen DH,Hoekstra RM,Vulule JM,Luby SP

    更新日期:2005-09-03 00:00:00

  • Patient characteristics and clinical caseload of short stay independent hospitals in England and Wales, 1992-3.

    abstract:OBJECTIVE:To describe and quantify the patients and clinical activities of independent short stay hospitals. DESIGN:Retrospective survey of hospital records for sampled periods of one financial year and comparison with data from 1981 to 1986. SETTING:217 independent hospitals in England and Wales, 1992-3. MAIN OUTCO...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.308.6945.1699

    authors: Williams BT,Nicholl JP

    更新日期:1994-06-25 00:00:00

  • Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991.

    abstract:OBJECTIVE:To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN:Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING:England and Wales. SUBJECTS:Children aged 0-15 years. MAIN OU...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7060.784

    authors: Roberts I,Power C

    更新日期:1996-09-28 00:00:00

  • Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study.

    abstract::Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammograph...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.j5224

    authors: Autier P,Boniol M,Koechlin A,Pizot C,Boniol M

    更新日期:2017-12-05 00:00:00

  • Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study.

    abstract:OBJECTIVE:To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN:Population based, prospective cohort study with follow-up over 15 years. SETTING:New South Wales, Australia. PARTICIPANTS:1642 men with localised prostate cancer, aged less than 70, an...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.m3503

    authors: Mazariego CG,Egger S,King MT,Juraskova I,Woo H,Berry M,Armstrong BK,Smith DP

    更新日期:2020-10-07 00:00:00

  • Informing participants of allocation to placebo at trial closure: postal survey.

    abstract:OBJECTIVES:To assess whether and how investigators of placebo controlled randomised trials inform participants of their treatment allocation at trial closure and to assess barriers to feedback. DESIGN:Postal survey with a semistructured questionnaire. PARTICIPANTS:All investigators who published a placebo controlled ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.325.7376.1329

    authors: Di Blasi Z,Kaptchuk TJ,Weinman J,Kleijnen J

    更新日期:2002-12-07 00:00:00

  • Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis.

    abstract:OBJECTIVE:To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. DESIGN:Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and pu...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.319.7224.1529

    authors: Forbes RB,Lees A,Waugh N,Swingler RJ

    更新日期:1999-12-11 00:00:00

  • Statin treatment for primary prevention of vascular disease: whom to treat? Cost-effectiveness analysis.

    abstract:OBJECTIVE:To assess the cost-effectiveness of low dose statins for primary prevention of vascular disease, incorporating current prices, non-adherence (reduced clinical efficacy while maintaining healthcare costs), and the results of the recently published JUPITER trial. DESIGN:Cost-effectiveness analysis using a Mark...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.d1672

    authors: Greving JP,Visseren FL,de Wit GA,Algra A

    更新日期:2011-03-30 00:00:00

  • Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots.

    abstract:OBJECTIVE:To observe the effects of stimulation of the sacral anterior roots on anorectal and low colonic pressures and to programme implanted stimulators to produce defecation. DESIGN:Prospective study of 12 consecutive patients. SETTING:Spinal injuries unit and university gastrointestinal physiology department. PA...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.300.6738.1494

    authors: MacDonagh RP,Sun WM,Smallwood R,Forster D,Read NW

    更新日期:1990-06-09 00:00:00

  • The New Zealand cervical cancer study: could it happen again?

    abstract::The author is one of the medical advisers to the judge who led a government inquiry into allegations that an experimental research program at the National Women's Hospital in Auckland, New Zealand, to study the natural course of cervical carcinoma in situ had withheld conventional treatment from some patients. She ar...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.297.6647.533

    authors: Paul C

    更新日期:1988-08-20 00:00:00

  • Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring.

    abstract:OBJECTIVE:To estimate trends between 1972-6 and 1996 in the prevalences of asthma and hay fever in adults. DESIGN:Two epidemiological surveys 20 years apart. Identical questions were asked about asthma, hay fever, and respiratory symptoms at each survey. SETTING:Renfrew and Paisley, two towns in the west of Scotland....

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.321.7253.88

    authors: Upton MN,McConnachie A,McSharry C,Hart CL,Smith GD,Gillis CR,Watt GC

    更新日期:2000-07-08 00:00:00

  • Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials.

    abstract:OBJECTIVE:To define the benefit of rice oral rehydration salts solution in relation to the glucose based World Health Organisation oral rehydration salts solution for treating and preventing dehydration in patients with severe dehydrating diarrhoea. DESIGN:Meta-analysis using data from 13 available randomised trials t...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.304.6822.287

    authors: Gore SM,Fontaine O,Pierce NF

    更新日期:1992-02-01 00:00:00

  • Tired, weak, or in need of rest: fatigue among general practice attenders.

    abstract:OBJECTIVES:To determine the prevalence and associations of symptoms of fatigue. DESIGN:Questionnaire survey. SETTING:London general practice. PARTICIPANTS:611 General practice attenders. MAIN OUTCOME MEASURES:Scores on a fatigue questionnaire and reasons given for fatigue. RESULTS:10.2% Of men (17/167) and 10.6% o...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.301.6762.1199

    authors: David A,Pelosi A,McDonald E,Stephens D,Ledger D,Rathbone R,Mann A

    更新日期:1990-11-24 00:00:00

  • Socioeconomic position in childhood and adulthood and insulin resistance: cross sectional survey using data from British women's heart and health study.

    abstract:OBJECTIVE:To assess the associations between childhood and adulthood social class and insulin resistance. DESIGN:Cross sectional survey. SETTING:23 towns across England, Scotland, and Wales. PARTICIPANTS:4286 women aged 60-79 years. MAIN OUTCOME MEASURES:Insulin resistance and other cardiovascular disease risk fact...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.325.7368.805

    authors: Lawlor DA,Ebrahim S,Davey Smith G,British women's heart and health study.

    更新日期:2002-10-12 00:00:00

  • Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care?

    abstract:OBJECTIVES:To determine the strength of evidence for the effectiveness of mental health interventions for patients with three common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain). To assess whether results obtained in secondary care can be extrapolated to primary care an...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.325.7372.1082

    authors: Raine R,Haines A,Sensky T,Hutchings A,Larkin K,Black N

    更新日期:2002-11-09 00:00:00

  • Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database.

    abstract:OBJECTIVE:To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression. DESIGN:Cohort study. SETTING:Patients registered with UK general practices contributing data to the QResearch database. PARTICIPANTS:238,963 patients...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.h517

    authors: Coupland C,Hill T,Morriss R,Arthur A,Moore M,Hippisley-Cox J

    更新日期:2015-02-18 00:00:00

  • Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis.

    abstract:OBJECTIVE:To determine the association between exposure to radiotherapy for the treatment of prostate cancer and subsequent second malignancies (second primary cancers). DESIGN:Systematic review and meta-analysis of observational studies. DATA SOURCES:Medline and Embase up to 6 April 2015 with no restrictions on year...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.i851

    authors: Wallis CJ,Mahar AL,Choo R,Herschorn S,Kodama RT,Shah PS,Danjoux C,Narod SA,Nam RK

    更新日期:2016-03-02 00:00:00

  • Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis.

    abstract:OBJECTIVES:To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs. DESIGN:Randomised c...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38558.393669.E0

    authors: McManus RJ,Mant J,Roalfe A,Oakes RA,Bryan S,Pattison HM,Hobbs FD

    更新日期:2005-09-03 00:00:00