ArticlePloS one2016
Modelling the Impact and Cost-Effectiveness of Biomarker Tests as Compared with Pathogen-Specific Diagnostics in the Management of Undifferentiated Fever in Remote Tropical Settings.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 4 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review.The Journal of antimicrobial chemotherapy · 2024Pooled it
- Usefulness of C-Reactive Protein and Other Host BioMarker Point-of-Care Tests in the Assessment of Non-Malarial Acute Febrile Illnesses: A Systematic Review with Meta-Analysis.The American journal of tropical medicine and hygiene · 2020Pooled it
- A systematic review of the economic impact of rapid diagnostic tests for dengue.BMC health services research · 2017Pooled it
- Estimating the burden of scrub typhus: A systematic review.PLoS neglected tropical diseases · 2017Pooled it
- Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2020Trial
- Deciphering the "Doxycycline Deficiency Syndrome": Defining the Characteristic Clinical, Laboratory and Imaging Findings in Patients Presenting with Leptospirosis, Q Fever and Rickettsial Diseases in Far North Queensland, Tropical Australia.Tropical medicine and infectious disease · 2026Article
- Cost-effectiveness analysis of point-of-care tests for causes of non-malarial febrile illnesses in low-resource settings: a case study from Lao PDR.BMJ public health · 2026Article
- Operational evaluation of the deployment of Malaria/CRP Duo and Dengue Duo rapid diagnostic tests for the management of febrile illness by village malaria workers in rural Cambodia.BMC infectious diseases · 2025Article
- Understanding Acceptability and Willingness-to-pay for a C-reactive Protein Point-of-care Testing Service to Improve Antibiotic Dispensing for Respiratory Infections in Vietnamese Pharmacies: A Mixed-methods Study.Open forum infectious diseases · 2024Article
- The Global Burden of Sepsis and Septic Shock.Epidemiologia (Basel, Switzerland) · 2024Review
- Biomarkers in pulmonary infections: a clinical approach.Annals of intensive care · 2024Review
- Cost-effectiveness analysis of a multiplex lateral flow rapid diagnostic test for acute non-malarial febrile illness in rural Cambodia and Bangladesh.The Lancet regional health. Southeast Asia · 2024Article
- Does diagnostic testing always decrease antibiotics prescriptions?The European journal of health economics : HEPAC : health economics in prevention and care · 2023Article
- C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review.JAC-antimicrobial resistance · 2023Review
- Article
- A robust host-response-based signature distinguishes bacterial and viral infections across diverse global populations.Cell reports. Medicine · 2022Article
- Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?BMC infectious diseases · 2022Article
- Comparison of the Serion IgM ELISA and Microscopic Agglutination Test for diagnosis of Leptospira spp. infections in sera from different geographical origins and estimation of Leptospira seroprevalence in the Wiwa indigenous population from Colombia.PLoS neglected tropical diseases · 2022Article
- Simple clinical and laboratory predictors to improve empirical treatment strategies in areas of high scrub typhus and dengue endemicity, central Vietnam.PLoS neglected tropical diseases · 2022Article
- High Frequency of Antibiotic Prescription in Children With Undifferentiated Febrile Illness in Kenya.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundMalaria accounts for a small fraction of febrile cases in increasingly large areas of the malaria endemic world. Point-of-care tests to improve the management of non-malarial fevers appropriate for primary care are few, consisting of either diagnostic tests for specific pathogens or testing for biomarkers of host response that indicate whether antibiotics might be required. The impact and cost-effectiveness of these approaches are relatively unexplored and methods to do so are not well-developed.
methodsWe model the ability of dengue and scrub typhus rapid tests to inform antibiotic treatment, as compared with testing for elevated C-Reactive Protein (CRP), a biomarker of host-inflammation. Using data on causes of fever in rural Laos, we estimate the proportion of outpatients that would be correctly classified as requiring an antibiotic and the likely cost-effectiveness of the approaches.
resultsUse of either pathogen-specific test slightly increased the proportion of patients correctly classified as requiring antibiotics. CRP testing was consistently superior to the pathogen-specific tests, despite heterogeneity in causes of fever. All testing strategies are likely to result in higher average costs, but only the scrub typhus and CRP tests are likely to be cost-effective when considering direct health benefits, with median cost per disability adjusted life year averted of approximately $48 USD and $94 USD, respectively.
conclusionsTesting for viral infections is unlikely to be cost-effective when considering only direct health benefits to patients. Testing for prevalent bacterial pathogens can be cost-effective, having the benefit of informing not only whether treatment is required, but also as to the most appropriate antibiotic; this advantage, however, varies widely in response to heterogeneity in causes of fever. Testing for biomarkers of host inflammation is likely to be consistently cost-effective despite high heterogeneity, and can also offer substantial reductions in over-use of antimicrobials in viral infections.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.