{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T15:02:56Z","timestamp":1781362976344,"version":"3.54.1"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["Grant reference NIH FIC\/R01EY031894"],"award-info":[{"award-number":["Grant reference NIH FIC\/R01EY031894"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>No distinctive clinical signs of Ebola virus disease (EVD) have prompted the development of rapid screening tools or called for a new approach to screening suspected Ebola cases. New screening approaches require evidence of clinical benefit and economic efficiency. As of now, no evidence or defined algorithm exists.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate, from a healthcare perspective, the efficiency of incorporating Ebola prediction scores and rapid diagnostic tests into the EVD screening algorithm during an outbreak.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We collected data on rapid diagnostic tests (RDTs) and prediction scores\u2019 accuracy measurements, e.g., sensitivity and specificity, and the cost of case management and RDT screening in EVD suspect cases. The overall cost of healthcare services (PPE, procedure time, and standard-of-care (SOC) costs) per suspected patient and diagnostic confirmation of EVD were calculated. We also collected the EVD prevalence among suspects from the literature. We created an analytical decision model to assess the efficiency of eight screening strategies: 1) Screening suspect cases with the WHO case definition for Ebola suspects, 2) Screening suspect cases with the ECPS at -3 points of cut-off, 3) Screening suspect cases with the ECPS as a joint test, 4) Screening suspect cases with the ECPS as a conditional test, 5) Screening suspect cases with the WHO case definition, then QuickNavi\u2122-Ebola RDT, 6) Screening suspect cases with the ECPS at -3 points of cut-off and QuickNavi\u2122-Ebola RDT, 7) Screening suspect cases with the ECPS as a conditional test and QuickNavi\u2122-Ebola RDT, and 8) Screening suspect cases with the ECPS as a joint test and QuickNavi\u2122-Ebola RDT. We performed a cost-effectiveness analysis to identify an algorithm that minimizes the cost per patient correctly classified. We performed a one-way and probabilistic sensitivity analysis to test the robustness of our findings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Our analysis found dual ECPS as a conditional test with the QuickNavi\u2122-Ebola RDT algorithm to be the most cost-effective screening algorithm for EVD, with an effectiveness of 0.86. The cost-effectiveness ratio was 106.7 USD per patient correctly classified. The following algorithms, the ECPS as a conditional test with an effectiveness of 0.80 and an efficiency of 111.5 USD per patient correctly classified and the ECPS as a joint test with the QuickNavi\u2122-Ebola RDT algorithm with an effectiveness of 0.81 and a cost-effectiveness ratio of 131.5 USD per patient correctly classified. These findings were sensitive to variations in the prevalence of EVD in suspected population and the sensitivity of the QuickNavi\u2122-Ebola RDT.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Findings from this study showed that prediction scores and RDT could improve Ebola screening. The use of the ECPS as a conditional test algorithm and the dual ECPS as a conditional test and then the QuickNavi\u2122-Ebola RDT algorithm are the best screening choices because they are more efficient and lower the number of confirmation tests and overall care costs during an EBOV epidemic.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0293077","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T17:28:41Z","timestamp":1697563721000},"page":"e0293077","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2440-8468","authenticated-orcid":true,"given":"Antoine Oloma","family":"Tshomba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mukadi-Bamuleka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"De Weggheleire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier M.","family":"Tshiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles T.","family":"Kayembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placide","family":"Mbala-Kingebeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Jacques","family":"Muyembe-Tamfum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Ahuka-Mundeke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faustin M.","family":"Chenge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart Karl M.","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5886-2004","authenticated-orcid":true,"given":"Dieudonn\u00e9 N.","family":"Mumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9sir\u00e9 D.","family":"Tshala-Katumbay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabue","family":"Mulangu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"pone.0293077.ref001","doi-asserted-by":"crossref","DOI":"10.7554\/eLife.09015","article-title":"Ebola virus disease in the Democratic Republic of the Congo, 1976\u20132014.","volume":"4","author":"A Rosello","year":"2015","journal-title":"Elife"},{"issue":"16","key":"pone.0293077.ref002","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1056\/NEJMoa1411100","article-title":"Ebola virus disease in West Africa\u2014the first 9 months of the epidemic and forward projections","volume":"371","author":"W. 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definition recommendations for Ebola or Marburg Virus Diseases"},{"key":"pone.0293077.ref031","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.epidem.2013.11.002","article-title":"Probabilistic uncertainty analysis of epidemiological modeling to guide public health intervention policy.","volume":"6","author":"JA Gilbert","year":"2014","journal-title":"Epidemics."},{"issue":"10","key":"pone.0293077.ref032","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1093\/cid\/ciw114","article-title":"Transmissibility and Pathogenicity of Ebola Virus: A Systematic Review and Meta-analysis of Household Secondary Attack Rate and Asymptomatic Infection","volume":"62","author":"NE Dean","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"12","key":"pone.0293077.ref033","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/S1473-3099(14)70995-8","article-title":"Dynamics and control of Ebola virus transmission in Montserrado, Liberia: a mathematical modelling 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