Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

Abstract

BackgroundRapid diagnostic tests (RDT) for malaria have been demonstrated to be effective and they should replace microscopy in certain areas.MethodThe cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters.ResultsIn the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US$ 35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™.ConclusionThe analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be the most cost-effective strategy of the six technologies evaluated. However, if used exclusively for diagnosing malaria, microscopy would be the worst use of resources. Microscopy would not be the most cost-effective strategy, even when structure is shared with other programmes, when the probability of a patient having access to it was reduced. Under these circumstances, the RDT CareStart™ would be the most cost-effective strategy.

Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

“…In the research protocol “economic decision models for genomic testing strategies”, Peters et al (2015) commented that it is rare for economic studies to provide suitable information about the methods used to evaluate how the evidence was identified 7 . A similar situation was observed in this review, since only two of the 12 articles on cost-effectiveness that were reviewed actually described the evaluation process used to determine the quality of the primary studies 44 , 53 .…”

“…The only CUA, which used DALY as an outcome, applied the estimates of sensitivity and specificity as epidemiological parameters in the decision model and the variations in these measures in the sensitivity analysis. Two studies (17%) referred to the application of methods defined in the literature to check the quality of the accuracy studies that underpinned the economic model 44 , 53 .…”

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

“…Decision-makers are being faced with increasingly difficult decisions when they consider the addition of new technologies to national malaria control program [ 28 ]. Aiming to help in decision-making, various economic studies have examined aspects related to primary prevention, diagnosis and treatment of malaria, with emphasis on vaccines [ 29 , 30 ], mosquito nets impregnated with insecticides [ 31 , 32 ], mass screening followed by treatment [ 33 ], use of RDTs to diagnose the infection [ 34 , 35 ] and the use of schemes for chemo-prophylaxis and treatment [ 36 – 38 ]. Although there are no published studies on cost-effectiveness for G6PDd diagnosis in connection with malaria, recent publications have discussed the urgency of evaluating the efficiency of RDTs used to detect G6PDd so as to guarantee safety in the treatment of these patients [ 11 , 13 , 14 ].…”

G6PD deficiency in male individuals infected by Plasmodium vivax malaria in the Brazilian Amazon: a cost study

“…Although studies were not identified in the literature that evaluate the cost of G6PDd in the context under research, there are recent publications that indicate how urgent it is to carry out economic evaluations on this topic, highlighting especially the need to estimate the costs and effectiveness of incorporating rapid diagnostic tests (RDTs) to detect G6PDd. These should be used at the point of care before applying PQ [ 4 , 6 , 46 ], similar to what has been described in the Brazilian context in relation to the cost-effectiveness of RDTs for diagnosing malaria itself [ 30 , 47 ], helping in decision-making on the incorporation or not of this technology. Currently, two RDTs to detect G6PDd in field conditions (BinaxNOW® G6PD and CareStartTM G6PD) have been evaluated in malaria endemic areas [ 48 , 49 ].…”