Cost-effectiveness analysis of rapid diagnostic tests for G6PD deficiency in patients with Plasmodium vivax malaria in the Brazilian Amazon

Abstract

BackgroundThe use of primaquine (PQ) for radical treatment of Plasmodium vivax in carriers of G6PD deficiency (G6PDd) constitutes the main factor associated with severe haemolysis in G6PDd. The current study aimed to estimate the incremental cost-effectiveness ratio of using a rapid diagnostic test (RDT) to detect G6PDd in male patients with P.vivax malaria in the Brazilian Amazon, in comparison with the routine indicated by the Programme for Malaria Control, which does not include this evaluation.MethodsA cost-effectiveness analysis of estimated RDT use was carried out for the Brazilian Amazon for the year 2013, considering the perspective of the Brazilian Public Health System. Using decision trees, estimates were compared for two different RDT strategies for G6PDd in male individuals infected with P. vivax before being prescribed PQ, with the routine indicated in Brazil, which does not include prior diagnosis of G6PDd. The first strategy considered the combined use of RDT BinaxNOW® G6PD (BX-G6PD) in municipalities with more than 100,000 inhabitants and the routine programme (RP) for the other municipalities. Operational limitations related to the required temperature control and venous blood collection currently restrict the use of RDT BX-G6PD in small municipalities. The second strategy considered the use of the RDT CareStart™ G6PD (CS-G6PD) in 100 % of the municipalities. The analysis was carried out for the outcomes: “adequately diagnosed case” and “hospitalization avoided”.ResultsFor the outcome “adequately diagnosed case”, comparing the RDT strategies based on RDT with the routine control programme (RP), the CS-G6PD strategy was the most cost-effective, with BX-G6PD extendedly dominating (the ICER of BX-G6PD compared with RP was higher than the ICER of CS-G6PD compared with RP). CS-G6PD dominated the other strategies for the “hospitalization avoided” outcome.ConclusionThe CS-G6PD strategy is cost-effective for adequately diagnosing cases and avoiding hospitalization. This information can help in decision-making, both in incorporating prior diagnosis in the use of PQ and to promote greater safety among G6PD deficient individuals in the Brazilian Amazon P. vivax endemic areas.

Costs and Cost-Effectiveness of Plasmodium vivax Control

“…The results are presented in Table 1 (diagnosis and treatment) and Table 2 (vector control). All the identified studies were based on intervention trials, except for one study on the cost-effectiveness of diagnosis and treatment in the Brazilian Amazon 32. The number of studies on P. vivax was much less than the substantial literature on P. falciparum 10.…”

Rapid diagnostic test for G6PD deficiency in Plasmodium vivax‐infected men: a budget impact analysis based in Brazilian Amazon

“…vivax before PQ indication. The choice of CS‐G6PD was made based on this being the RDT with the highest efficiency in a recently published cost‐effectiveness analysis .…”

“…Based on 87 928 males diagnosed with vivax malaria in 2013, incidence in subsequent years was estimated as follows: 70 342 for 2014, and 56 274 for 2015. The budget impact analysis used the same assumptions as in a recently published cost‐effectiveness analysis .…”

“…Results from economic studies can help decision‐making about incorporating efficient rapid diagnostic tests (RDTs) to diagnose G6PDd as part of safer programs advocating the use of PQ . The difficulty of obtaining accurate epidemiological parameters such as prevalence of G6PDd, probability and frequency of relapses and likelihood of haemolysis and death, in addition to costs related to RDT use and hospitalisations, can limit the development of such studies in most malaria‐endemic areas.…”

“…A recent assessment from the Brazilian health system (SUS) perspective, regarding efficiency of RDTs for detecting G6PDd in patients with P . vivax in the Brazilian Amazon found that RDT CareStart™ G6PD (CS‐G6PD) use for G6PDd diagnosis towards preventing hospitalisation is cost‐effective .…”