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

PLoS Negl Trop Dis. 2022 Mar 24;16(3):e0010325. doi: 10.1371/journal.pntd.0010325. eCollection 2022 Mar.


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 8% of one Brazilian gross domestic product per capita (US$6,822). The uncertainties evaluated in the sensitivity analysis did not significantly affect 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antimalarials* / therapeutic use
  • Brazil
  • Cost-Benefit Analysis
  • Glucosephosphate Dehydrogenase Deficiency* / diagnosis
  • Humans
  • Malaria, Vivax* / diagnosis
  • Malaria, Vivax* / drug therapy
  • Plasmodium vivax
  • Primaquine / therapeutic use


  • Antimalarials
  • Primaquine

Grant support

This study was funded by the Bill and Melinda Gates Foundation [Grant OPP1183951 to MVGL]. JDB-S is supported by the Research Support Foundation of Amazonas (FAPEAM). WMM, MVGL and VSS are fellows of the National Council for Scientific and Technological Development (CNPq). FAPEAM also funded this work through Pró-Estado [grant 005/2019 to WMM] and POSGRAD public calls. The Oswaldo Cruz Foundation (Fiocruz) also funded this work through project n° 1702179682 (Produtos Inovadores/INOVA public call). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.