PMID- 21390277
OWN - NLM
STAT- MEDLINE
DCOM- 20110901
LR  - 20211020
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 6
IP  - 2
DP  - 2011 Feb 24
TI  - Likely health outcomes for untreated acute febrile illness in the tropics in 
      decision and economic models; a Delphi survey.
PG  - e17439
LID - 10.1371/journal.pone.0017439 [doi]
LID - e17439
AB  - 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.
FAU - Lubell, Yoel
AU  - Lubell Y
AD  - London School of Hygiene & Tropical Medicine, London, United Kingdom. 
      yoel@tropmedres.ac
FAU - Staedke, Sarah G
AU  - Staedke SG
FAU - Greenwood, Brian M
AU  - Greenwood BM
FAU - Kamya, Moses R
AU  - Kamya MR
FAU - Molyneux, Malcolm
AU  - Molyneux M
FAU - Newton, Paul N
AU  - Newton PN
FAU - Reyburn, Hugh
AU  - Reyburn H
FAU - Snow, Robert W
AU  - Snow RW
FAU - D'Alessandro, Umberto
AU  - D'Alessandro U
FAU - English, Mike
AU  - English M
FAU - Day, Nick
AU  - Day N
FAU - Kremsner, Peter
AU  - Kremsner P
FAU - Dondorp, Arjen
AU  - Dondorp A
FAU - Mbacham, Wilfred
AU  - Mbacham W
FAU - Dorsey, Grant
AU  - Dorsey G
FAU - Owusu-Agyei, Seth
AU  - Owusu-Agyei S
FAU - Maitland, Kathryn
AU  - Maitland K
FAU - Krishna, Sanjeev
AU  - Krishna S
FAU - Newton, Charles
AU  - Newton C
FAU - Pasvol, Geoffrey
AU  - Pasvol G
FAU - Taylor, Terrie
AU  - Taylor T
FAU - von Seidlein, Lorenz
AU  - von Seidlein L
FAU - White, Nicholas J
AU  - White NJ
FAU - Binka, Fred
AU  - Binka F
FAU - Mills, Anne
AU  - Mills A
FAU - Whitty, Christopher J M
AU  - Whitty CJ
LA  - eng
GR  - 076827/WT_/Wellcome Trust/United Kingdom
GR  - 079080/WT_/Wellcome Trust/United Kingdom
GR  - 093956/WT_/Wellcome Trust/United Kingdom
GR  - 097170/WT_/Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110224
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Critical Illness/economics/epidemiology/therapy
MH  - *Decision Support Techniques
MH  - Delphi Technique
MH  - Disease Progression
MH  - Fever/complications/*diagnosis/*economics/epidemiology
MH  - Health
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Malaria/diagnosis/economics/epidemiology
MH  - *Models, Economic
MH  - Outcome Assessment, Health Care/methods/statistics & numerical data
MH  - Probability
MH  - Prognosis
MH  - *Tropical Climate
MH  - Young Adult
PMC - PMC3044764
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2011/03/11 06:00
MHDA- 2011/09/02 06:00
PMCR- 2011/02/24
CRDT- 2011/03/11 06:00
PHST- 2010/08/20 00:00 [received]
PHST- 2011/02/03 00:00 [accepted]
PHST- 2011/03/11 06:00 [entrez]
PHST- 2011/03/11 06:00 [pubmed]
PHST- 2011/09/02 06:00 [medline]
PHST- 2011/02/24 00:00 [pmc-release]
AID - PONE-D-10-01332 [pii]
AID - 10.1371/journal.pone.0017439 [doi]
PST - epublish
SO  - PLoS One. 2011 Feb 24;6(2):e17439. doi: 10.1371/journal.pone.0017439.