A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food

Abubakar I, Irvine L, Aldus CF, Wyatt GM, Fordham R, Schelenz S, et al
Record ID 32007000536
English
Authors' objectives:

"This systematic review focused on the use of rapid tests for six bacterial food-borne pathogens: Salmonella, Campylobacter, Escherichia coli O157, Clostridium perfringens, Staphylococcus aureus and Bacillus cereus. Diagnostic accuracy was assessed, and an economic model was subsequently developed, assessing costs and cost-effectiveness of PCR and immunoassays, compared with culture."

(from executive summary)

Authors' recommendations: Evidence from this systematic review suggests that rapid diagnostic assays, especially PCR, for Salmonella, Campylobacter and E. coli O157 are highly accurate. Less is known about the benefits of testing for toxin-producing pathogens and the significance of additional positives detected by these assays. It is unclear whether the additional benefits derived from early diagnosis and more sensitive detection can justify the large set-up costs of rapid tests, particularly if they remain diagnostic adjuncts to culture. Any decisions regarding the use of these assays must consider the speed of diagnosis (including transportation and reporting delays), effect on clinical outcome and costs of implementation simultaneously. Implications for research The effectiveness and cost-effectiveness of emerging tests for more than one organism at a time, such as multiplex PCR and DNA microarrays technologies, require further investigation. Substantial evidence suggests that rapid assays may be more sensitive than culture methods. Attempting to evaluate diagnostic tests in the absence of a true gold standard creates methodological challenges. Implications for practice The feasibility of conversion to rapid methods is dependent on localised considerations, including the community prevalence rates for specific pathogens, the skill base and subsequent training costs for laboratory staff and spare capacity available to ensure adequate laboratory space for new equipment. Although these tests show good promise for the future, further studies are needed to assess their immediate use in practice.
Authors' methods: Review
Details
Project Status: Completed
URL for project: http://www.hta.ac.uk/1445
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Disease Outbreaks
  • Public Health
  • Bacterial Infections
  • Feces
  • Food Microbiology
  • Gastrointestinal Diseases
  • Microbiological Techniques
Contact
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.