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

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 th...

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Bibliographic Details
Published in:	PLoS neglected tropical diseases 2022-03, Vol.16 (3), p.e0010325
Main Authors:	Brito-Sousa, Jose Diego, Peixoto, Henry M, Devine, Angela, Silva-Neto, Alexandre V, Balieiro, Patricia C S, Sampaio, Vanderson S, Vitor-Silva, Sheila, Mendes, Maxwell O, Souza, Brenda K A, Lacerda, Marcus V G, Monteiro, Wuelton M
Format:	Article
Language:	eng
Subjects:	Analysis Antimalarials Antimalarials - therapeutic use Biology and Life Sciences Brazil Care and treatment Complications and side effects Cost analysis Cost benefit analysis Decision trees Diagnosis Dosage and administration Economic aspects Engineering and Technology Enzymes Females Glucose 6 phosphate dehydrogenase Glucose-6-phosphate dehydrogenase deficiency Glucosephosphate dehydrogenase Glucosephosphate Dehydrogenase Deficiency - diagnosis Hospitalization Human diseases Humans Information systems Malaria Malaria, Vivax - diagnosis Malaria, Vivax - drug therapy Males Medical screening Medicine and Health Sciences Methods Monte Carlo simulation Municipalities Patients People and places Phosphates Plasmodium vivax Primaquine Primaquine - therapeutic use Probability Public health Risk factors Sensitivity analysis Social Sciences Tafenoquine Tropical diseases Vector-borne diseases
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Summary:	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. 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 8% of one Brazilian gross domestic product per capita (US$6,822). The uncertainties evaluated in the sensitivity analysis did not significantly affect the ICER identified in the base-case. 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.
ISSN:	1935-2735 1935-2727 1935-2735