Cost-Effectiveness Analysis of Sex-Stratified Plasmodium vivax Treatment Strategies Using Available G6PD Diagnostics to Accelerate Access to Radical Cure

Devine, Angela; Howes, Rosalind E.; Price, David J.; Moore, Kerryn A.; Ley, Benedikt; Simpson, Julie A.; Dittrich, Sabine; Price, Ric

doi:10.4269/ajtmh.19-0943

Cited by 11 publications

(10 citation statements)

References 35 publications

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“…Even those who will not be prescribed tafenoquine will benefit from radical cure in Brazil, as patients with G6PD activity of 30–70% will receive 7-day primaquine and those with <30% activity will receive weekly primaquine. Sex-guided treatment strategies may potentially ensure widespread use of tafenoquine for radical cure in low resource settings [ 37 ]. Future research should examine the ICER of tafenoquine.…”

Section: Discussionmentioning

confidence: 99%

Real-life quantitative G6PD screening in Plasmodium vivax patients in the Brazilian Amazon: A cost-effectiveness analysis

et al. 2022

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Background As quantitative glucose 6-phosphate dehydrogenase deficiency (G6PDd) screening tools are evaluated in operational studies, questions remain as to whether they are cost-effective. Here, a cost-effectiveness analysis (CEA) was performed to estimate the Incremental Cost-effectiveness Ratio (ICER) of the introduction of quantitative screening test to detect G6PDd among P. vivax carriers in two municipalities in the Brazilian Amazon. Methodology/Principal findings This cost-effectiveness analysis evaluated the use of the Standard G6PD quantitative screening test in vivax malaria treatment units in two municipalities of the Brazilian Amazon. Using the perspective of the Brazilian public health system, the analysis was performed for the outcome ‘PQ-associated hospitalization avoided’, based on a decision tree model. The results indicated that the G6PDd screening strategy compared with the routine strategy was highly cost-effective, with an ICER of US$495 per additional hospitalization avoided, which represented less than 10% of one Brazilian gross domestic product per capita (US$6,822). The uncertainties evaluated in the sensitivity analysis did not influence the ICER identified in the base-case. Conclusions/Significance This cost-effectiveness analysis showed the quantitative G6PD testing was effective in avoiding PQ-associated hospitalizations. The incorporation of G6PD screening is of paramount importance towards P. vivax malaria elimination in the Amazon to promote the safe use of primaquine and tafenoquine.

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Section: Discussionmentioning

confidence: 99%

Real-life quantitative G6PD screening in Plasmodium vivax patients in the Brazilian Amazon: A cost-effectiveness analysis

et al. 2022

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“…Thus, for rolling out TQ in endemic areas, more stringent screening of G6PD activity with quantitative tests is needed [111,140]. A recent cost-effectiveness analysis suggests that TQ may be deployed in endemic areas outside sub-Saharan Africa using a gender-specific strategy where G6PD-normal females can be prescribed a low-dose PQ for 14 days [141]. This approach again centers on the availability of a qualitative G6PD test.…”

Section: G6pd Deficiency and Point-of-care Testingmentioning

confidence: 99%

Elimination ofPlasmodium vivaxMalaria: Problems and Solutions

Brashear¹,

Menezes²,

Adams³

2021

Current Topics and Emerging Issues in Malaria Elimination

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Malaria is caused by multiple parasitic species of the genus Plasmodium. Although P. falciparum accounts for the highest mortality, P. vivax is the most geographically dispersed and the most common species outside of Africa. Several unique biological features make P. vivax less responsive to conventional control measures and allow it to persist even after elimination of P. falciparum. The ability of P. vivax to develop in diverse vectors at lower ambient temperatures bestows it a greater distribution range and resilience to ecological changes. Its tropism for reticulocytes often causes low-density infections below the levels detectable by routine diagnostic tests, demanding the development of more sensitive diagnostics. P. vivax produces gametocytes early enabling transmission before the manifestation of clinical symptoms, thus emphasizing the need for an integrated vector control strategy. More importantly, its dormant liver stage which engenders relapse is difficult to diagnose and treat. The deployment of available treatments for the liver hypnozoites, including primaquine and the recent U.S. Food and Drug Administration-approved tafenoquine, requires point-of-care diagnostics to detect glucose-6-phosphate dehydrogenase deficiency among endemic human populations. Here we review the continued challenges to effectively control P. vivax and explore integrated technologies and targeted strategies for the elimination of vivax malaria.

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“…In a study conducted in Vietnam, Indonesia, Afghanistan, and Ethiopia on the sex-based treatment for Pv radical cure, G6PD qualitative tests were used with the referral services for G6PD quantitative tests. Female patients with normal G6PD results were referred to a different facility for G6PD quantitative tests and further Pv radical cure treatment with Tafenoquine [ 21 ]. The study reported that referral of female patients for G6PD quantitative tests was less cost-effective than the non-referral option where PMQ 7 days regimen was provided after the normal result from G6PD qualitative tests.…”

Section: Introductionmentioning

confidence: 99%

“…The study reported that referral of female patients for G6PD quantitative tests was less cost-effective than the non-referral option where PMQ 7 days regimen was provided after the normal result from G6PD qualitative tests. However, only qualitative G6PD test was studied among males [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of G6PD diagnostic test for Plasmodium vivax radical cure in Lao PDR: An economic modelling study

et al. 2022

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Background Plasmodium vivax (Pv) infections were 68% of the total malaria burden in Laos in 2019. The parasite causes frequent relapses, which can be prevented by primaquine (PMQ). Testing for glucose-6-phosphate-dehydrogenase (G6PD) deficiency is recommended before giving PMQ to avoid haemolysis. Because of the risk of haemolysis in G6PD intermediate deficiencies among females, Laos uses the PMQ 14-days regimen only in G6PD normal females. Among G6PD point-of-care tests, qualitative tests cannot differentiate between G6PD normal and intermediate females. Quantitative tests are required to differentiate between G6PD normal and intermediate deficiencies. However, the quantitative test lacks the cost-effectiveness evidence necessary for decision-making for large-scale adoption. This study examined the cost-effectiveness of quantitative G6PD test, with either supervised PMQ treatment or unsupervised PMQ treatment, against the usual unsupervised PMQ 8-weeks strategy. Supervised PMQ 8-weeks strategy without G6PD testing was also compared against the unsupervised PMQ 8-weeks strategy since the former had recently been adopted in malaria high burden villages that had village malaria volunteers. A budget impact analysis was conducted to understand the incremental cost and effect needed for a nationwide scale-up of the chosen strategy. Methods A decision tree model compared the cost-effectiveness of implementing four strategies at one health facility with an average of 14 Pv cases in one year. The strategies were unsupervised PMQ strategy, supervised PMQ strategy, G6PD test with unsupervised PMQ strategy, and G6PD test with supervised PMQ strategy. Disability Adjusted Life Years (DALYs) was the effect measure. Costs were calculated from a payer perspective, and sensitivity analyses were conducted. One Gross Domestic Product (GDP) per capita of Laos was set as the cost-effectiveness threshold. Budget impact analysis was conducted using the health facility wise Pv data in Laos in 2020. Findings Supervised PMQ strategy was extendedly dominated by G6PD test strategies. When compared against the unsupervised PMQ strategy, both G6PD test strategies were more costly but more effective. Their Incremental Cost-Effectiveness Ratios (ICER) were 96.72US$ for the G6PD test with unsupervised PMQ strategy and 184.86US$ for the G6PD test with supervised PMQ strategy. Both ICERs were lower than one GDP per capita in Laos. Following the sensitivity analysis, low adherence for PMQ 14 days made both G6PD test strategies less cost-effective. The lower the Pv case number reported in a health facility, the higher the ICER was. In the budget impact analysis, the expected budget need was only half a million US$ when the G6PD test rollout was discriminately done depending on the Pv case number reported at the health facilities. Indiscriminate roll out of G6PD test to all health facilities was most expensive with least effect impact.

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Cost-Effectiveness Analysis of Sex-Stratified Plasmodium vivax Treatment Strategies Using Available G6PD Diagnostics to Accelerate Access to Radical Cure

Cited by 11 publications

References 35 publications

Real-life quantitative G6PD screening in Plasmodium vivax patients in the Brazilian Amazon: A cost-effectiveness analysis

Real-life quantitative G6PD screening in Plasmodium vivax patients in the Brazilian Amazon: A cost-effectiveness analysis

Elimination ofPlasmodium vivaxMalaria: Problems and Solutions

Cost-effectiveness analysis of G6PD diagnostic test for Plasmodium vivax radical cure in Lao PDR: An economic modelling study

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