The cost-effectiveness of tafenoquine following screening with STANDARD™ G6PD screening for the treatment of vivax malaria in the Brazilian Public Health System.
other · Level IV
Where this comes from
- Record sourced from PubMed, PMID 40978565.
- Also identified by DOI 10.1016/j.lana.2025.101216 and PMC identifier 12445694.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Vivax malaria requires radical cure to clear both the blood-stage and liver-stage parasites. Brazil, like most endemic countries, has been prescribing a 7-day primaquine regimen for radical cure without testing for glucose-6-phosphate-dehydrogenase (G6PD) deficiency to exclude those at risk of primaquine-induced haemolysis. Tafenoquine, a new single-dose drug for radical cure requires G6PD screening before prescription to ensure safety. This study aims to assess the cost-effectiveness of prescribing tafenoquine after semi-quantitative G6PD screening from the Brazilian Public Health System perspective. A decision tree model was developed for adults presenting with vivax malaria over 12-months. The <i>tafenoquine strategy</i> of semi-quantitative G6PD testing before prescription of single-dose tafenoquine to those with ≥70% G6PD activity was compared with: (1) <i>current practice</i>: 7-day low-dose primaquine (0.5 mg/kg/day) without G6PD screening and (2) <i>primaquine screening strategy:</i> 7-day low-dose primaquine (0.5 mg/kg/day) for patients with ≥30% G6PD activity determined by semi-quantitative G6PD screening. The primary outcome was the cost per disability-adjusted life-year (DALY) averted, compared with the Brazilian willingness-to-pay threshold of US$7752 (R$40,000). The <i>tafenoquine strategy</i> was US$2894 (R$14,934) per DALY averted compared to <i>current practice</i>, well below the willingness-to-pay threshold. The <i>tafenoquine strategy</i> dominated the <i>primaquine screening strategy</i>, averting 0.14 DALYs with cost savings of US$13 (R$66). In both comparisons, the <i>tafenoquine strategy</i> had a >98% likelihood of being cost-effective. The prescription of tafenoquine to those who test G6PD normal with a semi-quantitative test is a cost-effective strategy for the radical cure of vivax malaria in Brazil. While the cost-effectiveness in other settings may vary due to differences in costs and the epidemiology of vivax malaria and G6PD deficiency, the robustness of these findings should be reassuring, particularly where healthcare facilities expect to see a large number of patients annually. Medicines for Malaria Ventures.