A review of the cost-effectiveness of using near-patient G6PD tests before treatment with radical cure of vivax malaria

Background Currently, primaquine and tafenoquine are the only available drugs to kill the dormant liver-stage parasites of Plasmodium vivax and P. ovale spp . Since both drugs can cause life-threatening hemolytic events in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, G6PD screening is recommended before their prescription. This review assesses the evidence of the cost-effectiveness of near-patient G6PD tests for informing the treatment of vivax malaria. Methods A systematic search of the available literature was conducted to identify studies examining the cost-effectiveness of G6PD screening. Data on location, type of G6PD test utilized, placement of screening in the healthcare system, prevalence of G6PD deficiency, probability of hemolysis, perspective for the analysis, and model assumptions, including adherence to primaquine regimens were extracted from each study alongside data on associated costs and cost-effectiveness. Costs were inflated to 2023 United States dollars (US$) to aid comparability across results. Results Seven model-based studies reporting 16 cost-effectiveness comparisons were identified, including two qualitative tests (AccessBio’s CareStart™ G6PD Rapid Diagnostic Test and Abbott’s BinaxNOW™ G6PD Test) and one semi-quantitative test (SD Biosensor’s STANDARD™ G6PD Test). The majority of results were from Brazil with the remaining comparisons for Afghanistan, Ethiopia, Indonesia, Laos, Thailand, and Vietnam. The cost per person screened for G6PD deficiency ranged from US$ 1–16. The SD Biosensor analyser and test strip costs were US$ 171–832 and US$ 5–10, respectively. Most comparisons (88%, 14/16) found that compared G6PD screening before radical cure would be cost-effective as compared to radical cure without G6PD screening. Conclusions Although limited research has been conducted to determine the cost-effectiveness of near-patient G6PD tests, the available results highlight a high likelihood that these tests could be cost-effective and potentially cost saving depending on the setting. Given the high level of heterogeneity in the epidemiology of P. vivax malaria and G6PD deficiency and in the model assumptions, caution should be taken when extrapolating the findings to other endemic settings. This work was part of the evidence that informed the 2024 World Health Organization malaria treatment guidelines for near-patient G6PD testing.