Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Monteiro WM, Val FFA, Siqueira AM, Franca GP, Sampaio VS, Melo GC, et al.. G6PD deficiency in Latin America: systematic review on prevalence and variants. Mem Inst Oswaldo Cruz. 2014;109: 553–68. doi: 10.1590/0074-0276140123 - DOI - PMC - PubMed
    1. Recht J, Ashley EA, White NJ. Use of primaquine and glucose-6-phosphate dehydrogenase deficiency testing: Divergent policies and practices in malaria endemic countries. PLoS Negl Trop Dis. Public Library of Science; 2018;12: e0006230–e0006230. doi: 10.1371/journal.pntd.0006230 - DOI - PMC - PubMed
    1. Monteiro WM, Franca GP, Melo GC, Queiroz AL, Brito M, Peixoto HM, et al.. Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes. Malar J. 2014;13: 70. doi: 10.1186/1475-2875-13-70 - DOI - PMC - PubMed
    1. Brito-Sousa JD, Santos TC, Avalos S, Fontecha G, Melo GC, Val F, et al.. Clinical Spectrum of Primaquine-induced Hemolysis in Glucose-6-Phosphate Dehydrogenase Deficiency: A 9-Year Hospitalization-based Study From the Brazilian Amazon. Clin Infect Dis. 2019;69: 1440–1442. doi: 10.1093/cid/ciz122 - DOI - PubMed
    1. Peixoto HM, Brito MA, Romero GA, Monteiro WM, De Lacerda MV, De Oliveira MRF. G6PD deficiency in male individuals infected by Plasmodium vivax malaria in the Brazilian Amazon: A cost study. Malar J. 2015;16. doi: 10.1186/s12936-014-0534-x - DOI - PMC - PubMed

Publication types