Provider and household costs of Plasmodium vivax malaria episodes: a multicountry comparative analysis of primary trial data.

Angela Devine,Ric N Price,Tinh-Hien Tran,Kim Gilchrist,Huong-Thu Pham,Viet-Thanh Ngo,Justin A Green,Kamala Thriemer,Thuy-Nhien Nguyen,Ghulam Rahim Awab,Ayodhia P Pasaribu,Gavin Ckw Koh,Asrat Hailu,Febrina Contantia,Nicholas Pj Day,Tedlla Teferi,Walter Rj Taylor,Yoel Lubell

doi:10.2471/blt.18.226688

Abstract

ObjectiveTo determine household and health-care provider costs associated with Plasmodium vivax infection across a range of endemic settings.MethodsWe collected cost data alongside three multicentre clinical trials of P. vivax treatment in Afghanistan, Brazil, Colombia, Ethiopia, Indonesia, Philippines, Peru, Thailand and Viet Nam conducted between April 2014 to December 2017. We derived household costs from trial participant surveys administered at enrolment and again 2 weeks later to determine the costs of treatment and transportation, and the number of days that patients and their household caregivers were unable to undertake their usual activities. We determined costs of routine care by health-care providers by micro-costing the resources used to diagnose and treat P. vivax at the study sites.FindingsThe mean total household costs ranged from 8.7 United States dollars (US$; standard deviation, SD: 4.3) in Afghanistan to US$ 254.7 (SD: 148.4) in Colombia. Across all countries, productivity losses were the largest household cost component, resulting in mean indirect costs ranging from US$ 5.3 (SD: 3.0) to US$ 220.8 (SD: 158.40). The range of health-care provider costs for routine care was US$ 3.6–6.6. The cost of administering a glucose-6-phosphate-dehydrogenase rapid diagnostic test, ranged from US$ 0.9 to 13.5, consistently lower than the costs of the widely-used fluorescent spot test (US$ 6.3 to 17.4).ConclusionAn episode of P. vivax malaria results in high costs to households. The costs of diagnosing and treating P. vivax are important inputs for future cost–effectiveness analyses to ensure optimal allocation of resources for malaria elimination.

Highlights

Outside Sub-Saharan Africa, Plasmodium vivax is the predominant cause of malaria, affecting 14.0 million patients in 2016.1 While cost–effectiveness analyses can inform the efficient provision of health-care interventions, information on the costs for providers, patients and their households should be available
The costs of P. vivax malaria infection are potentially different from those infection caused by P. falciparum, since P. vivax forms liver stages, which lie dormant for weeks or months after the primary infection before reactivating to cause symptomatic infections
We report all costs in United States dollars (US$) for the year 2016

Summary

Introduction

Outside Sub-Saharan Africa, Plasmodium vivax is the predominant cause of malaria, affecting 14.0 million patients in 2016.1 While cost–effectiveness analyses can inform the efficient provision of health-care interventions, information on the costs for providers, patients and their households should be available. The costs of P. vivax malaria infection are potentially different from those infection caused by P. falciparum, since P. vivax forms liver stages (hypnozoites), which lie dormant for weeks or months after the primary infection before reactivating to cause symptomatic infections (relapses). Research Economic costs of P. vivax malaria episodes for G6PD deficiency is rarely offered.[11] This may change as new rapid diagnostic tests become more widely available to facilitate point-of-care testing. For G6PD-deficient individuals, an 8-week course of weekly primaquine doses is recommended[3] with monitoring for anaemia

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Discussion

Conclusion