Cost-Effectiveness of G6PD Screening
A single infection with Plasmodium vivax malaria can cause multiple episodes of illness due to dormant liver parasites called hypnozoites. Primaquine is the only currently available drug to treat hypnozoites but is under-used because it can cause life-threatening haemolyses (the rupture of red blood cells) in people who have an inherited condition called glucose-6-phosphate dehydrogenase (G6PD) deficiency. In other locations, primaquine is given without testing for G6PD deficiency, putting patients at unnecessary risk of haemolyses.
New rapid diagnostic tests provide the opportunity to screen for G6PD deficiency prior to primaquine treatment. We conducted a cost-effectiveness analysis for a Thailand-Myanmar border setting using data from a clinical trial at the Mae Sot-based Shoklo Malaria Research Unit (SMRU). A full description of our model has been published in PLOS Neglected Tropical Diseases.
We found that screening for G6PD deficiency could lead to better health outcomes at little or no cost to the healthcare providers. The study includes an interactive online tool that can be adapted to other locations to examine the potential costs and benefits of using rapid diagnostic tests for G6PD in different scenarios. This tool provides a useful starting point for policy makers who can vary the assumptions made in the model to reflect local epidemiology and costs.