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

Henry M Peixoto,Gustavo A S Romero,Maria R F De Oliveira,Marcelo A M Brito,Wuelton M Monteiro,Marcus V G De Lacerda

doi:10.1186/s12936-016-1140-x

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.

Highlights

The use of primaquine (PQ) for radical treatment of Plasmodium vivax in carriers of glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDd) constitutes the main factor associated with severe haemolysis in G6PD deficiency (G6PDd)
The use of primaquine (PQ) for radical treatment of Plasmodium vivax in carriers of G6PD deficiency (G6PDd) constitutes the main factor associated with severe haemolysis, hospitalization and death in G6PDd individuals in Latin America, especially in males; cases of severe adverse events in females induced by PQ, have not been reported in the Brazilian Amazon [1, 2]
The strategy based on the use of CareStartTM G6PD (CS-G6PD) in 100 % of the population was more cost-effective when compared to routine programme (RP) and the strategy that combines BinaxNOW® G6PD (BX-G6PD) and RP (BX-G6PD strategy)

Summary

Introduction

The 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. The estimates are approximately 6000 hospitalizations per year for individuals with G6PDd as a result of using PQ, creating a substantial burden, of an estimated costing of US$ 4,858,108.87 per year, for the Brazilian Public Health Service (Sistema Único de Saúde/SUS) [6] In this context, detecting G6PDd before PQ is prescribed could contribute to improving treatment safety in people with G6PDd, preventing harm done to the efforts to control and eliminate malaria. The identification and implementation of a rapid, efficient and feasible diagnostic method in field conditions is a priority [8,9,10,11]

Methods

Results

Discussion

Conclusion