OBJECTIVES

Plasmodium vivax causes 89% of malaria cases in Brazil. P. vivax is a debilitating and deadly disease with significant economic impact. The introduction of the recently FDA-approved one-dose treatment with tafenoquine (TQ) faces a challenge: as is the case with primaquine (PQ), patients with a glucose-6-phosphate dehydrogenase deficiency (G6PDd) can suffer potentially serious complications, including hemolytic anemia. To mitigate this risk, PATH-Mologic are developing a point-of-care diagnostic test to identify patients’ G6PD status to safely administer TQ or PQ. We performed a cost-effectiveness analysis (CEA) of P. vivax control comparing two strategies: Gold standard G6PDd testing (GS) with PQ vs. PATH-Mologic RDT with TQ.

METHODS

The analysis was performed from the perspective of the Brazil’s public health system. We used a decision tree model parametrized using data from the literature and predictions for the costs of the RDT and tafenoquine. The outcomes of the analysis were cost per adequately diagnosed case, cost per hospitalization averted, and cost per relapse prevented.

RESULTS

The cost of GS-PQ was $46 compared to $110 for RDT-TQ. The sensitivity of GS was 0.98 compared to 1 for RDT and the relapse-free efficacy at six months was 0.9 with TQ compared to 0.77 with PQ. Our model indicates that the RDT-TQ was dominant for cost per adequately diagnosed case. The ICERs comparing RDT-TQ to GS-PQ were $1,776 per hospitalization averted and $14,141 per relapse prevented.

CONCLUSIONS

The PATH-Mologic RDT and TQ combination is cost-effective in terms of cost per adequate diagnosis. The cost-effectiveness with regard to cost per hospitalization averted and cost per relapse prevented depends on the willingness to pay of Brazil’s public health system for these outcomes. These findings can help the Brazilian government in considering the implementation of the intervention in malaria-endemic areas.