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Likely Health Outcomes for Untreated Acute Febrile Illness in the Tropics in Decision and Economic Models; A Delphi Survey

Lubell, Y; Staedke, SG; Greenwood, BM; Kamya, MR; Molyneux, M; Newton, PN; Reyburn, H; Snow, RW; D'Alessandro, U; English, M; et al. Lubell, Y; Staedke, SG; Greenwood, BM; Kamya, MR; Molyneux, M; Newton, PN; Reyburn, H; Snow, RW; D'Alessandro, U; English, M; Day, N; Kremsner, P; Dondorp, A; Mbacham, W; Dorsey, G; Owusu-Agyei, S; Maitland, K; Krishna, S; Newton, C; Pasvol, G; Taylor, T; von Seidlein, L; White, NJ; Binka, F; Mills, A; Whitty, CJ (2011) Likely Health Outcomes for Untreated Acute Febrile Illness in the Tropics in Decision and Economic Models; A Delphi Survey. PLOS ONE, 6 (2). e17439 (1) - e17439 (9). ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0017439
SGUL Authors: Krishna, Sanjeev

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Abstract

Background: Modelling is widely used to inform decisions about management of malaria and acute febrile illnesses. Most models depend on estimates of the probability that untreated patients with malaria or bacterial illnesses will progress to severe disease or death. However, data on these key parameters are lacking and assumptions are frequently made based on expert opinion. Widely diverse opinions can lead to conflicting outcomes in models they inform. Methods and Findings: A Delphi survey was conducted with malaria experts aiming to reach consensus on key parameters for public health and economic models, relating to the outcome of untreated febrile illnesses. Survey questions were stratified by malaria transmission intensity, patient age, and HIV prevalence. The impact of the variability in opinion on decision models is illustrated with a model previously used to assess the cost-effectiveness of malaria rapid diagnostic tests. Some consensus was reached around the probability that patients from higher transmission settings with untreated malaria would progress to severe disease (median 3%, inter-quartile range (IQR) 1–5%), and the probability that a non-malaria illness required antibiotics in areas of low HIV prevalence (median 20%). Children living in low transmission areas were considered to be at higher risk of progressing to severe malaria (median 30%, IQR 10–58%) than those from higher transmission areas (median 13%, IQR 7–30%). Estimates of the probability of dying from severe malaria were high in all settings (medians 60– 73%). However, opinions varied widely for most parameters, and did not converge on resurveying. Conclusions: This study highlights the uncertainty around potential consequences of untreated malaria and bacterial illnesses. The lack of consensus on most parameters, the wide range of estimates, and the impact of variability in estimates on model outputs, demonstrate the importance of sensitivity analysis for decision models employing expert opinion. Results of such models should be interpreted cautiously. The diversity of expert opinion should be recognised when policy options are debated.

Item Type: Article
Additional Information: Copyright: 2011 Lubell et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Acute Disease, Adolescent, Adult, Child, Child, Preschool, Critical Illness, Decision Support Techniques, Delphi Technique, Disease Progression, Fever, Health, Humans, Infant, Infant, Newborn, Malaria, Models, Economic, Outcome Assessment (Health Care), Probability, Prognosis, Tropical Climate, Young Adult, Science & Technology, Multidisciplinary Sciences, Science & Technology - Other Topics, MULTIDISCIPLINARY SCIENCES, SUB-SAHARAN AFRICA, COST-EFFECTIVENESS, COMBINATION THERAPY, SOUTH-AFRICA, MALARIA, CHILDREN, General Science & Technology, MD Multidisciplinary
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: PLOS ONE
ISSN: 1932-6203
Related URLs:
Dates:
DateEvent
24 February 2011Published
Web of Science ID: WOS:000287761700057
URI: http://openaccess.sgul.ac.uk/id/eprint/107062
Publisher's version: https://doi.org/10.1371/journal.pone.0017439

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