Malaria is no longer a common cause of febrile illness in many regions of the tropics. In part, this success is a result of improved access to accurate diagnosis and effective anti-malarial treatment, including in many hard-to-reach rural areas. However, in these settings, management of other causes of febrile illness remains challenging. Health systems are often weak and other than malaria rapid tests no other diagnostics are available. With millions of deaths occurring annually due to treatable bacterial infections and the ever increasing spread of antimicrobial resistance, improvement in the management of febrile illness is a global public health priority. Whilst numerous promising point-of-care diagnostics are in the pipeline, substantial progress can be made in the interim with existing tools: C-reactive protein (CRP) is a highly sensitive and moderately specific biomarker of bacterial infection and has been in clinical use for these purposes for decades, with dozens of low-cost devices commercially available. This paper takes a health-economics approach to consider the possible advantages of CRP point-of-care tests alongside rapid diagnostic tests for malaria, potentially in a single multiplex device, to guide antimicrobial therapy for patients with febrile illness. Three rudimentary assessments of the costs and benefits of this approach all indicate that this is likely to be cost-effective when considering the incremental costs of the CRP tests as compared with either (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns in areas of low transmission. While CRP-guided antibiotic therapy alone cannot resolve all challenges associated with management of febrile illness in remote tropical settings, in the short-term a multiplexed CRP and malaria RDT could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs. These findings should spark further interest amongst industry, academics and policy-makers in the development and deployment of such diagnostics, and discussion on their geographically appropriate use.

中文翻译：

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经济上的考虑支持C反应蛋白测试和疟疾快速诊断测试，以指导在疟疾流行率较低的地区对高热疾病患者进行抗菌治疗。

在热带的许多地区，疟疾已不再是导致高热病的常见原因。这种成功的部分原因是包括在许多难以到达的农村地区，人们获得更多准确诊断和有效抗疟疾治疗的结果。但是，在这些情况下，其他高热病因的治疗仍然具有挑战性。卫生系统通常薄弱，除疟疾快速检测外，没有其他诊断方法可用。由于可治疗的细菌感染以及抗菌素耐药性的不断增加，每年有数百万的死亡发生，因此改善发热性疾病的管理已成为全球公共卫生的重点。尽管有许多有前途的即时诊断服务正在准备中，但在使用现有工具的过渡中可以取得实质性进展：C反应蛋白（CRP）是细菌感染的一种高度敏感和中等特异性的生物标志物，几十年来已在临床上用于这些目的，并且有数十种低成本设备可商购获得。本文采用健康经济学的方法来考虑CRP即时诊点测试以及针对疟疾的快速诊断测试（可能在单个多重设备中）的可能优势，以指导对高热病患者的抗菌治疗。对这种方法的成本和收益进行的三项基本评估均表明，与以下两种情况相比，考虑CRP测试的增量成本，这可能具有成本效益：（i）细菌性疾病患者的健康结果有所改善；（ii）避免了抗菌素耐药性的费用；（iii）在低传播地区更好地管理剩余的疟疾病例和缩短消除疟疾运动的经济利益。尽管仅靠CRP指导的抗生素治疗不能解决与偏远热带环境中的高热病管理相关的所有挑战，但在短期内，CRP和疟疾RDT的多重治疗可能具有很高的成本效益，并利用了已经建立的完善的资金和分配系统用于疟疾RDT。这些发现应引起行业，学术界和决策者对这种诊断仪的开发和部署，以及就其在地理上的适当使用进行讨论的进一步兴趣。尽管仅靠CRP指导的抗生素治疗不能解决与偏远热带环境中的高热病管理相关的所有挑战，但在短期内，CRP和疟疾RDT的多重治疗可能具有很高的成本效益，并利用了已经建立的完善的资金和分配系统用于疟疾RDT。这些发现应引起行业，学术界和决策者对这种诊断仪的开发和部署，以及就其在地理上的适当使用进行讨论的进一步兴趣。尽管仅靠CRP指导的抗生素治疗不能解决与偏远热带地区高热病管理相关的所有挑战，但短期内CRP和疟疾RDT的多重治疗可能具有很高的成本效益，并利用了已经建立的完善的资金和分配系统用于疟疾RDT。这些发现应引起行业，学术界和决策者对这种诊断仪的开发和部署，以及就其在地理上的适当使用进行讨论的进一步兴趣。