Quicker malaria diagnosis

Major gains can be made in combating malaria at only a modest extra cost. That is the conclusion of the University of Twente and Philips in an advisory report to the Brazilian government on new diagnosis technology. The study was recently presented at an academic conference in Paris.

Demonstrating the social impact of new technologies from the earliest stages of design and development - the University of Twente is striking out into new territory with this study, as professor and chair of Health Technology & Services Research group Maarten IJzerman explains. "Our advice to Philips is a great example. We make early predictions about the health gains and cost effectiveness of new technologies for malaria diagnosis."

Malaria, infectious disease number one with 1.5 million victims worldwide, is also a huge problem in Brazil. Although healthcare facilities are reasonable, people have to come to hospital from far and wide. And if their blood samples first have to be sent to central laboratories, treatment can be delayed quite a while.

Point of care technology

Rather than taking the patient to the healthcare system, it is better to do the opposite: doctors diagnose malaria at the point of care itself. To enable this, Philips had the option of investing in two different technologies: Magneto Optical Technology (MOT) or Software Aided Microscopy (SAM). "Our task as the University of Twente," IJzerman continues, "was to compare the performances of these designs with how malaria is currently diagnosed. To this end, we developed a decision model, a Markov model, for the Brazilian situation. 

"This model was used to establish how often an incorrect diagnosis is made. In principle, two things can go wrong: either technology fails or it is used improperly. If people are wrongly diagnosed as having malaria (error negatives), the avoidable costs will quickly mount up. And the second risk: denial of care simply because they have not been earmarked as a patient (error positives) of course affects life expectancy."

Health gains

Software Aided Microscopy (SAM) came out best for both technical possibilities. Its integration into the existing medical structure is enough for Brazil to achieve substantial improvements: using the model, researchers predict a health gain of about 150,000 human lives a year; access to diagnosis rises from 31% to 80%. It is also the best economic scenario. If the government were only to improve current diagnosis to 80%, that would mean an investment of USD22 million and a health gain of 100,000 lives, while a combination with SAM delivers one and half times as great a health gain at a cost of USD16 million.

Breast cancer

Under IJzerman, the University of Twente Health Technology & Services Research group is conducting other, similar studies into the efficiency of healthcare methods. "Together with researchers from MIRA, the University of Twente Institute for Biomedical Technology and Technical Medicine, we are working intensively on imaging and diagnostics. For instance, we are looking at the health gains and efficiency which photo-acoustic imaging can provide in detecting breast cancer. We take two basic implementation scenarios here: the first as a screening instrument and the second as a supplement to the hospital diagnosis of breast cancer.

"Another example is that we conduct research in conjunction with a company, such as Medimate, and Albert van den Berg's research group into the potential gains provided by lab-on-a-chip technology. For example, whether sodium or potassium chips can bring health gains to patients with heart or kidney failure. Close cooperation with the Euregion trauma region and the regional acute care body means that we can test this type of technology in practice."

"Our research field has huge potential. According to a recent publication by The Economist, the US alone is to spend an additional USD70 billion on personal medical monitoring devices over the next ten years. That is almost as much as the total cost of medical devices in the US. Obtaining the correct information to take decisions will only serve to increase the role played by diagnosis and imaging."

Note for the press:

Copies of the study "The health economic impact of new malaria diagnostic technologies on malaria control in Brazil" (Breedge Quinn) are available on request.