Summary


Cost-effectiveness analysis of radical cure strategies for Plasmodium vivax

Tafenoquine alongside quantitative screening for glucose-6-phosphate dehydrogenase (G6PD) deficiency provides new opportunities for the treatment and control of Plasmodium vivax malaria. This tool is designed to help malaria control programs and decision makers start to think about the cost-effectiveness of different options for the treatment of vivax malaria, including:
Strategy 1 is unsupervised primaquine without G6PD screening.
Strategy 2 is unsupervised primaquine after screening with a qualitative G6PD test.
Strategy 3 is unsupervised primaquine after screening with a quantitative G6PD test.
Strategy 4 is tafenoquine after screening with a quantitative G6PD test.

The initial model parameters are set for adult patients (aged 16+) in Ethiopia, drawing largely on data from the IMPROV trial. Further details on the input values and how to update these are found in the dictionary. Users can switch between using low or high dose primaquine for Strategies 1-3, but the efficacy of tafenoquine remains equal to low-dose primaquine. Only the costs to the healthcare providers are included.

While this is a helpful tool to see how inputs impact the results, we recommend doing a full cost-effectiveness analysis with sensitivity analyses before changing policy.



Decision Tree


Click on each node to expand and follow each path




Model Inputs


Change values to vary the model inputs





Percent of females with severe G6PD deficiency (<30% activity):


Percent of females with intermediate G6PD deficiency (30-70% activity):




Model Outputs



Strategy 1: No G6PD test + PQ

Strategy 2: Qualitative G6PD test + PQ

Strategy 3: Quantitative G6PD test + PQ

Strategy 4: Quantitative G6PD test + TQ

Strategy 1: No G6PD test + PQ

Strategy 2: Qualitative G6PD test + PQ

Strategy 3: Quantitative G6PD test + PQ

Strategy 4: Quantitative G6PD test + TQ

*DALYs represent healthy years of life lost. Smaller values are better

Incremental cost-effectiveness ratios are calculated using standard methods that require multiple steps due to having more than two strategies in the comparison. First, the strategies are ordered from lowest to highest cost. The next step is to check that each strategy averts more DALYs than the one listed before it. If not, then that strategy is not cost-effective due to simple dominance; so the incremental costs, incremental DALYs, and ICERs are not calculated. The next step is to calculate the ICERs (incremental costs/DALYs averted), starting with a comparison between the least costly strategy (listed first) and the next remaining strategy in the list. If the ICER for a strategy is larger than the next strategy listed, then that strategy is removed from the analysis due to extended analysis. The next strategy in the analysis is then compared to the previous strategy that is still included in the analysis