Rapid diagnostic test for G6<scp>PD</scp> deficiency in <i>Plasmodium vivax</i>‐infected men: a budget impact analysis based in Brazilian Amazon

Peixoto, Henry Maia; Brito, Marcelo Augusto Mota; Romero, Gustavo Adolfo Sierra; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícius Guimarães; Oliveira, Maria Regina Fernandes de

doi:10.1111/tmi.12800

Cited by 4 publications

(5 citation statements)

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“…Previous CEAs have already demonstrated that strategies based on the use of the qualitative rapid diagnostic test (CareStart G6PD) were cost-effective [ 19 , 32 ], including in the Brazilian Amazon. Other studies have indicated that the strategy based on CareStart G6PD were cost-effective in avoiding hospitalization and showed a negative incremental budget impact [ 33 ]. Our study demonstrates that quantitative testing with SD biosensor remains cost-effective while including technological advantages, such as the important gains in diagnostic accuracy.…”

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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“…In places in which movements are not easily restricted–such as urban centres in which dog populations are contiguous–our study indicates that comprehensive vaccination coverage is crucial and that reducing population turnover (for example, by increasing veterinary care to improve dog health) might not have a substantial effect on reducing the vaccination coverage required. The political and operational challenges of rabies elimination are well-documented [50], and lack of elimination or subsequent re-emergence is attributed to insufficient vaccination coverage (< 70% dog population overall, patchy coverage or insufficient duration [49, 51, 52]) and re-introduction of infected dogs [48, 53]. Pockets of unvaccinated dogs within well-vaccinated, urban areas could maintain rabies at a low incidence sufficient to re-introduce rabies as surrounding herd immunity wanes.…”

Section: Discussionmentioning

confidence: 99%

Rabies-induced behavioural changes are key to rabies persistence in dog populations: Investigation using a network-based model

2019

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Canine rabies was endemic pre-urbanisation, yet little is known about how it persists in small populations of dogs typically seen in rural and remote regions. By simulating rabies outbreaks in such populations (50–90 dogs) using a network-based model, our objective was to determine if rabies-induced behavioural changes influence disease persistence. Behavioural changes–increased bite frequency and increased number or duration of contacts (disease-induced roaming or paralysis, respectively)–were found to be essential for disease propagation. Spread occurred in approximately 50% of model simulations and in these, very low case rates (2.0–2.6 cases/month) over long durations (95% range 20–473 days) were observed. Consequently, disease detection is a challenge, risking human infection and spread to other communities via dog movements. Even with 70% pre-emptive vaccination, spread occurred in >30% of model simulations (in these, median case rate was 1.5/month with 95% range of 15–275 days duration). We conclude that the social disruption caused by rabies-induced behavioural change is the key to explaining how rabies persists in small populations of dogs. Results suggest that vaccination of substantially greater than the recommended 70% of dog populations is required to prevent rabies emergence in currently free rural areas.

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“…At the individual level, it will enable the safe treatment of more patients with deficient and intermediate G6PD activity, diminishing the risk of recurrent malaria and acute hemolytic anemia (5,7,31,32). At the healthcare systems level, it could reduce the associated costs and the burden on transfusion services by reducing the number of hemolytic crises caused by PQ or TQ in individuals with unknown G6PD status and malaria treatment (5,7,31,33). Additionally, this could impact parasite transmission rates when combined with other interventions (5,7,31).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the Point-of-Care Standard G6PD test™ (SD Biosensor) for Glucose-6-phosphate dehydrogenase deficiency: a systematic review of the literature

Martínez,

Vélez-Marín,

Lopez-Perez

et al. 2024

Preprint

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Glucose-6-Phosphate Dehydrogenase deficiency (G6PDd) is a common genetic enzymopathy that can induce hemolysis triggered by various factors, including some anti-malarial drugs. Although many Point-of-Care (PoC) tests, such as STANDARD G6PDTMmanufactured by SD biosensor (StandG6PD-BS), are available to detect G6PDd, its pooled diagnostic test accuracy (DTA) remains unknown. To estimate the DTA of StandG6PD-BS at various thresholds of G6PDd, we conducted a systematic review with a DTA meta-analysis, searching EMBASE, MEDLINE, and SciELO databases up to June 30, 2023. We included studies measuring G6PD activity using StandG6PD-BS (reference test) and spectrophotometry (gold standard) in patients suspected of having G6PDd. We assessed the risk of bias (RoB) of the studies using the QUADAS-2 tool and the certainty of evidence (CoE) with the GRADE approach. Our approach included the estimation of within-study DTA, a random-effect bivariate meta-analysis to determine the pooled sensitivity and specificity for 30%, 70%, and 80% enzyme levels’ thresholds, and a graphical analysis of the heterogeneity using crosshair and Confidence Regions on receiver operating characteristic (ROC) space plots. After screening 2,407 reports, we included four studies with 7,864 participants covering all thresholds. Two studies had high RoB in QUADAS-2 domains 2 and 3, and the others had low RoB. We also found low, moderate, and high heterogeneity at the 30%, 70%, and 80% thresholds, respectively. The pooled sensitivity was 99.1% (95%CI 96.9-99.7%, CoE: high), 95.7% (92.0-97.0%, high), and 90% (78.0-96.5%, low) for 30%, 70%, and 80% thresholds, respectively. The pooled specificity was 97.4% (95%CI 95.0; 98.4%, high); 92.9% (85.0-96.4%, high); and 89.0% (76.0-96.0%, moderate) for 30%, 70%, and 80% thresholds, respectively. In conclusion, StandG6PD-BS is a PoC test with high sensitivity and specificity to detect G6PDd at different thresholds.Author summaryGlucose-6-Phosphate Dehydrogenase deficiency (G6PDd) is a common genetic disease that can induce the destruction of red blood cells leading to anemia triggered by various factors, including some drugs used for malaria treatment. After a literature search in different databases up to January 31, 2023, we pooled diagnostic test accuracy of the Point-of-Care (PoC) STANDARD G6PDTM test manufactured by SD biosensor (StandG6PD-BS) used to identify the G6PDd. Although two of the four studies included showed a high Risk of Bias related to the index test and the reference standard domains of the QUADAS-2 tool, the pooled sensitivity and specificity for 30%, 70%, and 80% enzyme levels’ thresholds were around 90%, with better sensitivity and specificity values for the 30% threshold (99.1% and 97.4%) compared with 70% (95.7% and 92.9%) and 80% (90% and 89%) threshold. We found low, moderate, and high heterogeneity at the 30%, 70%, and 80% thresholds. In conclusion, StandG6PD-BS is a PoC test with high sensitivity and specificity to detect G6PDd at different thresholds.

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

Cited by 4 publications

References 24 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

Rabies-induced behavioural changes are key to rabies persistence in dog populations: Investigation using a network-based model

Diagnostic accuracy of the Point-of-Care Standard G6PD test™ (SD Biosensor) for Glucose-6-phosphate dehydrogenase deficiency: a systematic review of the literature

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