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

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 10% of one Brazilian gross domestic product per capita (US$6,822). The uncertainties evaluated in the sensitivity analysis did not influence 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. Author summary: Although relatively known for over 50 years, G6PD deficiency still greatly impairs Plasmodium vivax malaria treatment due to primaquine-associated hemolysis (destruction of red blood cells). Several screening platforms are now available, which can be performed without specialized equipment and personnel, before providing malaria treatment. The main question is: in an already established public health system, would they be cost-effective to avoid the deleterious effect of hemolysis? This study evaluated the real use of the Standard G6PD screening test in two small municipalities in the Brazilian Amazon. Results show that the real-life use of the test was highly cost-effective when compared to a scenario with no routine G6PD screening. Hence, the negative clinical and economic consequences associated with inadvertent prescription of PQ to patients with G6PDd were diminished.