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. 2022 Mar 24;16(3):e0010325.
doi: 10.1371/journal.pntd.0010325. eCollection 2022 Mar.

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

Jose Diego Brito-Sousa  1   2 , Henry M Peixoto  3 , Angela Devine  4   5 , Alexandre V Silva-Neto  1   2 , Patricia C S Balieiro  1   2 , Vanderson S Sampaio  1   2   6 , Sheila Vitor-Silva  1   7 , Maxwell O Mendes  1 , Brenda K A Souza  1 , Marcus V G Lacerda  1   8 , Wuelton M Monteiro  1   2
Affiliations

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

Jose Diego Brito-Sousa et al. PLoS Negl Trop Dis. .

Abstract

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 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.

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Analytical decision tree model used for cost-effectiveness analysis.
Fig 2
Fig 2. Incremental Cost-effectiveness Ratio (ICER) Tornado diagram for univariate sensitivity analysis of routine strategy versus G6PDd screening strategy, based on the individual impact of each of the variables on the ICER.
The vertical line denotes the base-case expected value (EV).
Fig 3
Fig 3. Cost-effectiveness acceptability curve of routine strategy versus G6PDd screening strategy.
Brazilian Amazon, 2020.
See this image and copyright information in PMC

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