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

A review of the cost-effectiveness of using near-patient G6PD tests before treatment with radical cure of vivax malaria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A review of the cost-effectiveness of using near-patient G6PD tests before treatment with radical cure of vivax malaria Angela Devine This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8409096/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract 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. Vivax malaria G6PD deficiency screening costs cost-effectiveness BACKGROUND While the majority of the malaria burden is due to Plasmodium falciparum , P. vivax is the most widespread species and more common outside of sub-Saharan Africa [ 1 – 3 ]. P. vivax is more challenging to control, in part due to recurring malaria episodes called relapses, which are caused by its dormant liver-stage parasites. In order to prevent relapses, liver-stage treatment needs to be prescribed alongside the blood-stage treatment. Together this combination of treatments is called ‘radical cure’. Only two drugs are currently available to clear the liver-stage parasites. Primaquine is often prescribed either as 7-day or 14-day regimens, requiring patients to continue taking drugs long after symptoms have subsided. Primaquine efficacy is related to the total dose taken, limiting the effectiveness when patients are not adherent to their medications [ 4 ]. Primaquine regimens can either be low-dose (3.5 mg/kg total dose) or high-dose (7 mg/kg total dose), which have both been implemented through 7-day and 14-day regimens. Recent evidence has indicated that high-dose primaquine is more efficacious than low-dose in many settings [ 5 ]. More recently, tafenoquine has become available as a liver-stage treatment [ 6 , 7 ]. Tafenoquine is prescribed as a single dose (300 mg), alleviating the issues around adherence. Both primaquine and tafenoquine can cause severe hemolysis in patients with an enzymopathy called glucose-6-phosphate dehydrogenase (G6PD) deficiency, which tends to be more prevalent in P. vivax endemic settings [ 2 , 3 ]. G6PD deficiency is X-linked, meaning that males can be either hemizygous deficient or normal while females can be either homozygous deficient, normal, or heterozygous for the G6PD gene. Tafenoquine is longer acting than primaquine [ 8 ] and thus requires screening for G6PD deficiency before its prescription. G6PD screening is also recommended when possible before the prescription of primaquine, particularly for the high daily doses of primaquine [ 9 ]. G6PD tests can be either qualitative (a single threshold at 30% of normal G6PD activity), semi-quantitative (able to also distinguish 30–70% G6PD activity in G6PD intermediate patients with for moderate G6PD activity), or fully quantitative (able to distinguish a range of activities). Semi-quantitative tests can discriminate three categories of patients: deficient ( 70% activity). While near-patient screening for G6PD deficiency can enable the safety of radical cure regimens, which will be essential for the control and elimination of malaria, these tests bring additional costs to consider, including quality control and training. It is more challenging to determine the cost per person screened using a semi-quantitative test as compared to qualitative tests because the cost of the analyser needs to be applied at the facility level and is dependent on the number of patients and expected lifetime. This literature review summarizes the previous evidence regarding the cost-effectiveness of near-patient G6PD tests for informing the safe treatment of Plasmodium vivax . METHODS A systematic search of the available literature was conducted in PubMed in January 2024, including the terms ((g6pd) OR (glucose-6-phosphate dehydrogenase)) AND (cost-effectiveness) AND (vivax). For each study, data on location, G6PD test utilized, placement of screening in the healthcare system (e.g., clinic, hospital), prevalence of G6PD deficiency, probability of hemolysis, perspective for the analysis, and model assumptions, including adherence to primaquine regimens were extracted. The costs and assumptions for training on how to conduct the G6PD screening were also extracted. This was also done for hemolytic events related to treatment. To aid comparability, all costs extracted from the studies were inflated to 2023 US $ , which were reported alongside the cost year and currency as reported in each included study. Since most of the unit costs for G6PD screening were collected in US $ , gross domestic product (GDP) deflators for US $ were used to inflate costs to 2023 US $ [ 10 ]. For qualitative G6PD tests, the cost of the test and the cost per person screened were extracted. For semi-quantitative G6PD tests, the cost of the analyser, the test strip, batteries for the analyser, and quality assurance were extracted. In addition to the unit costs for the aforementioned items, the analyser cost per person screened is dependent on how long the analyser lasts before needing to be replaced (lifetime), the number of patients screened per year, and the discount rate. The discount rate is the amount that future costs are reduced, reflecting that people would prefer to have money now rather than in future years. A higher discount rate results in less value being attached to costs in the future. For example, a discount rate of 3.5% will result in $ 10 spent in Year 2 having a present value of $ 9.66 while a discount rate of 5% will result in the present value lowering to $ 9.52. Discount rates used in the analyses were also reported. The main outcome for cost-effectiveness analyses is called the incremental cost-effectiveness ratio (ICER). It is calculated by dividing the difference between the costs of two alternatives by the difference between their health outcomes. ICERs are interpreted as cost-effective if the values for a new intervention are below the cost-effectiveness threshold, which is pre-specified before conducting the analysis. While some countries have set cost-effectiveness thresholds to inform decision making, many do not. The health outcomes used in economic evaluations include disability-adjusted life-years (DALYs) and natural units. DALYs are a health outcome that captures both years of life lost and years of life with disability, enabling comparisons across different diseases [ 11 ]. The goal is to minimise DALYs. One-half to one GDP per capita per DALY averted is commonly used as the cost-effectiveness threshold for settings where a threshold has not been stated explicitly and thresholds based on opportunity costs are not available [ 12 , 13 ]. The use of DALYs enables the comparison with other disease programs (e.g., cancer). The use of natural units can include outcomes such as malaria cases averted, hospitalizations averted, and adequately diagnosed case. While these are not comparable with other diseases, they can be useful for decision making within the malaria control program. It is, however, unclear what an appropriate threshold would be for ICERs that use natural units as their outcomes, and these are likely to be context specific. In addition to the base case results, economic evaluations typically include one-way sensitivity analysis and probabilistic sensitivity analysis (PSA). A one-way sensitivity analysis is when an individual model parameter is varied to higher and lower values to see the impact of that parameter on the ICER. In contrast, a distribution is put around each model parameter for a PSA, and these are sampled at the same time for a number of model runs (often ≥ 1,000) to capture uncertainty across all model parameters. The results are used to construct a cost-effectiveness acceptability curve, which presents the percentage of model runs that had an ICER below the pre-specified cost-effectiveness threshold. The reported cost-effectiveness threshold and percentage of model runs below that threshold were extracted for each comparison. Since many papers reported the results for multiple countries and comparators, each comparison was extracted separately for the cost-effectiveness results. For each comparison, the time horizon, radical cure regimen(s) used, the ICER in reported currency, cost-effectiveness threshold, and probability of being cost-effective were extracted. All listed doses of primaquine and tafenoquine are the total dose prescribed. For each comparator using a qualitative test, the G6PD activity cut-offs used for each treatment strategy were also included. To aid comparability, results were presented in the following groups based on the comparators in each analysis: G6PD screening before radical cure compared with no radical cure Qualitative G6PD screening before radical cure compared with radical cure without G6PD screening Semi-quantitative G6PD screening before radical cure compared with radical cure without G6PD screening Two strategies with G6PD screening before radical cure. As with the unit costs, ICERs were inflated to 2023 US $ to aid comparability across results. RESULTS Six peer-reviewed studies were identified. An additional study by Peixoto et al . that had not been peer-reviewed at the time of this review was added to the results [ 14 ]; this work was submitted to the health technology assessment body, Brazilian National Commission for the Incorporation of Technology in the SUS ( Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde [CONITEC]) in 2023 as part of the approval process for G6PD screening before the prescription of tafenoquine and was published online in Portuguese [ 15 ]. When including the most recent Peixoto et al . study [ 14 ], the seven studies were published between 2016 and 2025; all took the healthcare provider perspective for defining the scope of the costs and benefits included in the primary analysis (Table 1 ). All studies reported costs in US $ with cost years ranging from 2013 to 2020. Table 1 Basic characteristics and epidemiological parameters as described by the included cost-effectiveness studies. Studies are listed in chronological order. Author (Year) Location G6PDd prevalence G6PD test Placement of screening Probability of hemolysis for G6PDd prescribed radical cure Perspective References & notes Peixoto (2016) Brazil 4.5% for males; • Females were not included in the analysis • BinaxNOW for municipalities with > 100,000 inhabitants • CareStart for 100% of municipalities Not explicitly stated but all patients with P. vivax were screened, implying all levels of the healthcare system 94.3% hospitalized Healthcare provider [ 18 ] Operational limitations related to the required temperature control and venous blood collection currently restrict the use of Binax NOW in small municipalities. One comparison for each G6PD test: these tests were not implemented concurrently. PQ adherence not considered. Devine (2017) Thai-Myanmar border 13.7% for males; 5.0% for female; 15.8% for intermediate females CareStart Clinic 11% need a blood transfusion if severe G6PD (0.5% if intermediate); 10% of those in need don’t receive a transfusion; 10% of those who don’t receive a transfusion die Healthcare provider [ 22 ] Included costs for the supervision of PQ so adherence was assumed to be 100%. Devine (2020) Afghanistan 7.0% for males; 4.0% for females CareStart Local clinic 11% need a blood transfusion; 10% don’t receive a transfusion; 10% of those who don’t receive a transfusion die Healthcare provider & societal [ 19 ] Adherence was 62% for PQ7; 47% for PQ14; 31% for PQ8W. The analyses included 3 options for females: 1) PQ14 (3.5mg/kg total); 2) PQ7 (7.0mg/kg total); 3) referral to a higher facility for semi-quantitative G6PD screening & TQ if > 70% activity. The results for PQ14 and referral to a higher facility for TQ were consistently dominated by PQ7 so not presented below. Ethiopia 1.0% for males; 1.0% for females Indonesia 7.0% for males; 4.0% for females Vietnam 5.0% for males; 3.0% for females Aung (2022) Laos 9.0% of males had < 30% G6PD activity; 13.0% of females had < 70% G6PD activity SD Biosensor STANDARD test Health center 13% hemolyze; 10% don't go to hospital; 10% of those who don't go to hospital die Healthcare provider [ 20 ] Adherence assumed to be 100% for all supervised regimens; 85% for unsupervised PQ14; 43% for unsupervised PQ8W. While supervised PQ14 (3.5mg/kg total) without G6PD screening was also included as a comparator, it was dominated so not presented below. Brito-Sousa (2022) Brazil 2.5% for males; 2.5% for females SD Biosensor STANDARD test Not explicitly stated but all patients with P. vivax were screened, implying all levels of the healthcare system 13% hospitalized Healthcare provider [ 17 ] Price (2024) Brazil G6PDd varied by province SD Biosensor STANDARD test Not explicitly stated but all patients with P. vivax were screened, implying all levels of the healthcare system 3.8% hemolyze if severe G6PDd (3.1% if intermediate G6PDd); 11% of those die Healthcare provider [ 16 ] Results are discounted by 5%. PQ7 adherence varied from 30–90% depending on the analysis. PQ8W was considered not effective so was not included [ 31 ]. G6PD activity score distribution was based on Markov chain Monte Carlo fitted Gaussian mixture models to 4 datasets (see also [ 31 ]). For 2 states in which survey data were not available a national-level prevalence of 5.52% G6PD deficiency was used. Peixoto (2025) Brazil 5.6% for males; 0.3% for female; 10.6% for intermediate female SD Biosensor STANDARD test Not explicitly stated but all patients with P. vivax were screened, implying all levels of the healthcare system 3.8% hemolyze if severe G6PDd (3.1% if intermediate G6PDd); 11% of those die Healthcare provider [ 14 ] While this work has not yet been peer reviewed, the results were published in Portuguese in the CONITEC report that enabled tafenoquine to be prescribed in Brazil [ 15 ]. PQ adherence was 67%. CONITEC = Brazilian National Commission for the Incorporation of Technology in the SUS ( Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde ); G6PD = glucose-6-phosphate dehydrogenase; G6PDd = glucose-6-phosphate dehydrogenase deficiency; PQ14 = 14-day primaquine; PQ7 = 7-day primaquine; PQ8W = weekly primaquine for 8 weeks; TQ = tafenoquine All studies used a model for their evaluations with a decision tree structure, except one study that used a transmission model coupled with an economic model [ 16 ]. Some studies involved multiple countries while others had multiple comparisons for the cost-effectiveness analyses. Four studies were set in Brazil [ 14 , 16 – 18 ] with the remaining three studies presented results for six other countries: Afghanistan [ 19 ], Ethiopia [ 19 ], Indonesia [ 19 ], Laos [ 20 ], Thailand [ 21 ], and Vietnam [ 19 ]. Three G6PD tests were evaluated: the qualitative CareStart™ G6PD rapid diagnostic tests (RDT)) by AccessBio [ 18 , 22 ], the qualitative BinaxNOW™ G6PD Test by Abbott [ 18 ], and the semi-quantitative test STANDARD™ G6PD by SD Biosensor [ 14 , 16 , 17 , 20 ]. Table 1 describes the key assumptions for each study included in the review. There was a high level of heterogeneity amongst the studies regarding the prevalence of G6PD deficiency (1-13.7%), the risk of hemolysis to G6PD deficient patients prescribed radical cure (3.8–94.3% hospitalized), which costs were included (e.g., staff training, quality assurance), and the comparators selected for the analyses. Assumptions regarding the prevalence of G6PD deficiency and probability of severe hemolysis can have a large impact on cost-effectiveness [ 18 , 19 ]. Training costs While not all studies reported the training costs required to educate healthcare workers on how to administer G6PD testing, the four most recent studies all included these costs [ 14 , 16 , 17 , 20 ]. For the four studies where it was possible to make the calculations, the training cost ranged from US $ 0.42 to US $ 29.07 per person screened for G6PD deficiency (Table 2 ). The largest cost estimate was from Laos, which reported both the highest cost per facility trained (US $ 407) and the lowest patient throughput (14 patients per year) [ 20 ]. One additional study estimated a cost of US $ 135 per year but did not report the average throughput per facility [ 16 ]. Table 2 Costs for training on the administration of glucose-6-phosphate dehydrogenase tests. Location [reference] G6PD test Reported currency 2024 US $ per person † Brazil [ 18 ] BinaxNOW & CareStart 2013 US $ 0.80/patient screened 1.03 Thailand [ 21 ] CareStart Not included - Afghanistan, Ethiopia, Indonesia & Vietnam [ 19 ] CareStart Not included - Laos [ 20 ] SD Biosensor 2020 US $ 351/facility/year 29.07* Brazil [ 17 ] SD Biosensor 2020 US $ 0.36/patient screened 0.42 Brazil [ 16 ] SD Biosensor 2020 US $ 58/healthcare worker/year 135/facility/year Brazil [ 14 ] SD Biosensor 2020 US $ 58/healthcare worker/year 2.45 ‡ US $ : United States dollars. † Unless otherwise stated. * 14 patients per healthcare facility per year. ‡ 55 patients per healthcare facility per year and 2 healthcare workers per facility. Hemolytic event costs The cost per hemolytic event ranged from US $ 49 in Ethiopia to US $ 407 in Thailand. (Table 3 ) The majority of costs (60%, 6/10) took a 7-day inpatient stay from WHO-CHOICE unit cost estimates [ 23 ] and added the cost of a unit of blood from a working paper on the unit costs of healthcare inputs in LMICs [ 24 ]. The remaining four studies from Brazil ranged in cost from US $ 87 to US $ 283, reflecting the range of sources and methods used to estimate them. Table 3 Hemolytic event costs in reported currency and 2023 United States dollars (US $ ) along with assumptions and original sources for unit costs where available. Location [reference] Reported currency 2023 US $ Assumptions Brazil [ 18 ] 2013 US $ 283 365 Includes pre-admission tests, medical appointments, hospital food, and hospitalization costs. Hospitalization costs were obtained from 108 patient files from the Hospital Information System (SIH/SUS) of the Brazilian Amazon in 2013. Thailand [ 21 ] 2014 US $ 321 407 One unit of blood from [ 24 ] and a 7-day inpatient stay from WHO-CHOICE [ 23 ]. Afghanistan [ 19 ] 2016 US $ 52 65 One unit of blood from [ 24 ] and a 7-day inpatient stay from WHO-CHOICE [ 23 ]. Ethiopia [ 19 ] 2016 US $ 39 49 One unit of blood from [ 24 ] and a 7-day inpatient stay from WHO-CHOICE [ 23 ]. Indonesia [ 19 ] 2016 US $ 181 225 One unit of blood from [ 24 ] and a 7-day inpatient stay from WHO-CHOICE [ 23 ]. Vietnam [ 19 ] 2016 US $ 99 123 One unit of blood from [ 24 ] and a 7-day inpatient stay from WHO-CHOICE [ 23 ]. Laos [ 20 ] 2020 US $ 116 135 One unit of blood from [ 24 ] and a 7-day inpatient stay from WHO-CHOICE [ 23 ]. Brazil [ 17 ] 2020 US $ 133 154 Pre-admission tests and hospitalization from [ 18 , 25 ] and medical appointments from [ 26 ] Brazil [ 16 ] 2020 US $ 87 101 Cost per episode from [ 27 ]. Brazil [ 14 ] 2020 US $ 87 101 Cost per episode from [ 27 ]. Qualitative test costs Overall, the unit cost of a qualitative G6PD test ranged from US $ 0.86 in Ethiopia to US $ 16.13 in Indonesia (Table 4 ). Of the seven unit costs, only one (14%) was for BinaxNOW. Most studies (86%, 6/7) reported the cost per person screened, which included things such as the cost of an additional blood draw and staff time to administer the test. The inclusion of these costs was not consistent across the studies. The resulting cost per person screened ranged from US $ 2.08 in Vietnam to US $ 19.09 in Indonesia (Table 2 ). Quality control and training costs did not appear to be included in any study. Table 4 Costs associated with qualitative glucose-6-phosphate dehydrogenase (G6PD) screening. Location [reference] Reported currency 2023 US $ Currency G6PD test cost Per person screened † G6PD test Per person screened Brazil [ 18 ] 2013 US $ 5.88 for BinaxNOW 9.01: Supplies and staff time $ 7.59 $ 11.62 Brazil [ 18 ] 2013 US $ 1.50 for CareStart 3.34: Supplies and staff time $ 1.94 $ 5.97 Thailand [ 21 ] 2014 US $ 1.75 for CareStart Only G6PD test cost reported $ 2.22 - Afghanistan [ 19 ] 2016 US $ 2.72 for CareStart* 3.42: Blood draw and staff time $ 3.38 $ 4.26 Ethiopia [ 19 ] 2016 US $ 0.69 for CareStart* 3.56: Blood draw and staff time $ 0.86 $ 4.43 Indonesia [ 19 ] 2016 US $ 12.96 for CareStart* 15.34: Blood draw and staff time $ 16.13 $ 19.09 Vietnam [ 19 ] 2016 US $ 0.96 for CareStart* 1.67: Blood draw and staff time $ 1.19 $ 2.08 US$ = United States Dollars † Lists items included in addition to the qualitative G6PD test cost. * Extracted from the original costing study [ 28 ]. Semi-quantitative test costs The only semi-quantitative point-of-care test studied was the SD Biosensor STANDARD test. Four studies used the SD Biosensor; with one study in Laos [ 20 ] and the other three in Brazil [ 14 , 16 , 17 ]. The need for a portable analyser to read the test strips increases the initial cost of rolling out the screening method with the cost per SD Biosensor analyser ranged from US $ 171 to US $ 832 (Table 3 ). While the studies in Brazil gave the analyser a lifetime of five years and a 5% discount rate [ 14 , 16 , 17 ], the study in Laos assumed three years and a 3% discount rate [ 20 ]. The SD Biosensor test strip unit cost ranged from US $ 5.00 in Laos to US $ 10.13 in Brazil (Table 3 ). Where stated, the patients screened by one analyser ranged from 14 to 68 per year. Quality assurance was reported in a variety of ways: per person screened, per month, per 3 months; and mainly focused on the cost of the controls. Only one study reported the cost per person screened, which was US $ 14.88 [ 17 ]. Table 3 Costs associated with semi-quantitative glucose-6-phosphate dehydrogenase (G6PD) screening in the review. All used the SD Biosensor STANDARD test. Quality assurance (QA) are annual costs at the facility level unless otherwise stated. Country [reference] Discount rate Lifetime Reported currency 2023 US $ Notes Currency Analyser Test strip QA Per person screened Analyser Test strip Annual QA Per person screened Laos [ 20 ] 3% 3 years 2020 US $ 148 4.31 89 Not reported 171 5.00 103 † - Costs were calculated at the facility level with each facility diagnosing 14 cases/year. Assumed an 8-month shelf life per box of test strips, resulting in a minimum of 37 strips/ facility/year. This would cover the strips needed for QA costs, which accordingly did not include test strip cost. QA was 22 every 3 months Brazil [ 17 ] 5% 5 years 2020 US $ 717 8.73 0.113 per person 12.82 832 10.13 8.92* 14.88 The per person quality assurance cost assumed US $ 9.50 for controls, which was divided by 20, then multiplied by the average number of controls per analyser in one year (16.22), then divided by the average number of tests per analyser in one year (68). It is not clear if QA included the cost of test strips to run the controls. Brazil [ 16 ] 5% 5 years 2020 US $ 619 6.80 240 Not reported 718 7.89 279 - Costs were calculated at the facility level, assuming 1.05 analysers per facility. The number of patients per year was not reported. Included 0.64 for additional blood draw for G6PD screening. QA was US $ 20 per facility monthly including the cost of one set of controls and 2 test strips to run the controls. Brazil [ 14 ] 5% 5 years 2020 US $ 619 6.75 74 Not reported 718 7.83 86 - Costs were calculated at the facility level with 55 patients/facility/year. QA only includes the monthly cost for controls. The cost of two test strips was included separately in the model calculations, making it equivalent in costs to [ 16 ]. Includes 3.3 for blood draw. US $ = United States dollars. † QA multiplied by 4. * Per person cost multiplied by 68 patients per year. Cost-effectiveness thresholds In Brazil, the health technology assessment body (CONITEC) has a stated threshold of 40,000 Brazilian reais [ 29 ]. Two of the studies from Brazil used this threshold for DALYs averted [ 14 , 16 ]. One study from Brazil used a threshold of one GDP per capita for the Amazon region was chosen for both natural unit outcomes it reported, implying that an adequately diagnosed case of malaria and a hospitalization averted were each equivalent to one year in perfect health [ 18 ]. A subsequent paper used the GDP per capita for Brazil as its threshold, stating that it is commonly used for hospitalizations averted for neglected diseases in Brazil [ 17 ]. While Thailand has a stated threshold of 160,000 Thai baht [ 30 ], a lower threshold was chosen for the analysis in Thailand to reflect the migrant population in that study [ 21 ]. The other countries did not have a stated cost-effectiveness threshold; GDP-based thresholds were used in those analyses. All studies conducted probabilistic sensitivity analysis (PSA), enabling the probability of being cost-effective at the chosen threshold to be extracted. Cost-effectiveness of G6PD screening before radical cure compared to no radical cure In total, the seven studies provided 21 comparisons for the cost-effectiveness results. Only two of these looked at G6PD screening before radical cure as compared to no radical cure (Table 2 ). Both used qualitative G6PD tests. In Ethiopia, the ICER was US $ 580 from the healthcare provider perspective, but this changed to the comparator with G6PD screening dominating no screening when the societal perspective was taken [ 19 ]. This means that G6PD screening improved health outcomes while saving money as compared to no radical cure. The ICER from the healthcare provider perspective was lower than the cost-effectiveness threshold of US $ 700 with a 50% probability of being cost-effective at that threshold. The second study was from the Thai-Myannar border, which resulted in ICERs of US $ 8.0 for males and US $ 14.8 for females with the corresponding probabilities of being cost-effective at the cost-effectiveness threshold of US $ 500 of 81% and 78%, respectively. Table 6 Cost-effectiveness results for studies that compared glucose-6-phosphate dehydrogenase (G6PD) screening before radical cure with no radical cure (current practice) in reported currency and 2023 United States dollars (US $ ). For all comparisons, incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year averted. Results are from the healthcare provider perspective unless otherwise specified. Location [reference]; time horizon G6PD test; radical cure regimen ICER in reported currency Cost-effectiveness threshold † Probability of being cost-effective ICER in 2023 US $ Thailand [ 21 ]; 1 year CareStart; PQ14 (7mg/kg) for G6PDn, PQ8W (6mg/kg) for G6PDd 2014 US $ 6.3 for males & 11.7 for females $ 500 81% for males & 78% for females 8.0 for males & 14.8 for females Ethiopia [ 19 ]; 1 year CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd 2016 US $ 466 (CareStart was dominant with cost savings of 4.6 and 0.0077 DALYs averted from the societal perspective) $ 700 (1 GDP/ capita) 50% 580 (CareStart was dominant with cost savings of 5.7 from the societal perspective) G6PDd = glucose-6-phosphate dehydrogenase; G6PDn = glucose-6-phosphate dehydrogenase normal; GDP = gross domestic product; kg = kilogram; mg = milligram; PQ14 = 14-day primaquine;PQ7 = 7-day primaquine; PQ8W = weekly primaquine for 8 weeks ; TQ = tafenoquine Table 7 Cost-effectiveness results for studies that compared qualitative glucose-6-phosphate dehydrogenase (G6PD) screening before radical cure with radical cure without G6PD screening in reported currency and 2023 United States dollars (US $ ). Incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year (DALY) averted from the healthcare provider perspective unless otherwise noted. Location [reference]; time horizon Comparators (current practice in bold text when included) ICER in reported currency Cost-effectiveness threshold † Probability of being cost-effective at the threshold ICER in 2023 US $ Brazil [ 18 ]; Follows male patients to end of malaria episode • PQ7* • BinaxNOW in municipalities with > 100,000 inhabitants; PQ7 for G6PDn, no radical cure for G6PDd 2013 US $ 10.0 per adequately diagnosed case 6480 (1 GDP per capita for the Amazon region) Not stated 12.9 per adequately diagnosed case Brazil [ 18 ]; Follows male patients to end of hospitalization • PQ7* • BinaxNOW in municipalities with > 100,000 inhabitants; PQ7 for G6PDn & no radical cure for G6PDd 2013 US $ 63.9 per hospitalization averted 6480 (1 GDP per capita for the Amazon region) Not stated 82.5 per hospitalization averted Brazil [ 18 ]; Follows male patients to end of malaria episode • PQ7 * • CareStart in 100% of municipalities; PQ7 for G6PDn, no radical cure for G6PDd 2013 US $ 4.3 per adequately diagnosed case 6480 (1 GDP per capita for the Amazon region) Not stated but appears to be ~ 100% 5.5 per adequately diagnosed case Brazil [ 18 ]; Follows male patients to end of hospitalization • PQ7 * • CareStart in 100% of municipalities; PQ7 for G6PDn, no radical cure for G6PDd CareStart was dominant with cost savings of 2013 US $ 0.1 and 0.0014 hospitalizations averted 6480 (1 GDP per capita for the Amazon region) Not stated but appears to be ~ 100% CareStart was dominant with cost savings of $ 0.1 Thailand [ 21 ]; 1 year • PQ14 (7mg/kg) • CareStart; PQ14 for G6PDn, PQ8W (6mg/kg) for G6PDd CareStart was dominant with cost savings of 2014 US $ 7.1 per male and $ 2.2 per female and 0.011 and 0.004 DALYs averted in males and females, respectively 500 98% for males. 91% for females CareStart was dominant with cost savings of 9.0 per male and 2.8 per female Afghanistan [ 19 ]; 1 year • PQ14 (3.5mg/kg) • CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd 2016 US $ 1089 (815 from the societal perspective) 600 (1 GDP/ capita) 15% • 1355 • 1014 Indonesia [ 19 ]; 1 year • PQ14 (3.5mg/kg) • CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd 2016 US $ 4443 (2028 from the societal perspective) 3600 (1 GDP/ capita) 23% • 5530 • 3520 Vietnam [ 19 ]; 1 year • PQ14 (3.5mg/kg) • CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd 2016 US $ 127 (CareStart was dominant with cost savings of 7.9 and 0.0068 DALYs averted from the societal perspective) 2200 (1 GDP/ capita) 98% • 158 • From the societal perspective, CareStart was dominant with cost savings of 9.8 G6PDd = glucose-6-phosphate dehydrogenase; G6PDn = glucose-6-phosphate dehydrogenase normal; GDP = gross domestic product; kg = kilogram; mg = milligram; PQ14 = 14-day primaquine; PQ7 = 7-day primaquine; PQ8W = weekly primaquine for 8 weeks; TQ = tafenoquine † As reported in the study. * While dose is not explicitly stated, 3.5mg/kg is used in Brazil. † As reported in the study. Cost-effectiveness of qualitative G6PD screening before radical cure compared to radical cure without G6PD screening Eight comparisons compared radical cure with and without G6PD screening before prescription. Two of these studies found that G6PD screening would reduce costs while averting DALYs in Brazil and Thailand [ 18 , 21 ] while an additional study in Vietnam showed domination when the societal perspective was taken [ 19 ]. For the study from Thailand, the one-way sensitivity analysis found that G6PD screening before primaquine was cost saving for all results except for when the qualitative G6PD test cost was raised to US $ 10.0, which caused an incremental cost for the screening strategy to 2014 US $ 235.9 and US $ 1602.1 for males and females, respectively [ 21 ]. The comparisons in Afghanistan and Indonesia both showed qualitative G6PD screening to be above the specified cost-effectiveness thresholds [ 19 ]. The remaining four comparisons found that G6PD screening would be cost-effective [ 18 , 19 ]. The results from the PSAs indicated that there was > 75% probability that G6PD screening would be cost-effective at the chosen cost-effectiveness thresholds in four comparisons, two comparisons (Afghanistan and Indonesia) had < 25% probability of being cost-effective, and two comparisons were not presented. The PSAs for Afghanistan and Indonesia showed that nearly all model iterations averted DALYs, indicating that the higher ICERs were driven by the increased costs of G6PD screening [ 19 ]. Cost-effectiveness of semi-quantitative G6PD screening before radical cure compared to radical cure without screening Eight comparisons evaluated radical cure prescription after semi-quantitative G6PD screening with radical cure prescription without G6PD screening. Only one comparison evaluated the use of the same radical cure regimen (PQ7 3.5mg/kg total dose) for both strategies in Brazil [ 17 ]. The other 5 comparisons in Brazil compared PQ7 (PQ7 3.5mg/kg total dose) without G6PD screening with tafenoquine prescribed after G6PD screening [ 14 , 16 , 17 ]. The remaining two comparisons were in Laos, comparing PQ8W without screening with supervised and unsupervised PQ14 (both 3.5mg/kg total dose) prescribed after G6PD screening. While two studies used the same unit costs and cost year for Brazil, the comparisons in Price et al . [ 31 ] were lower than those in Peixoto et al . [ 14 ] due to model structure (Price et al . includes the impact on transmission while Peixoto et al does not) and time horizon (1 year for this study as compared to 10 years in Price 2024). For 81% (13/16) of the comparisons, the results from the PSAs indicated that there was > 75% probability that G6PD screening would be cost-effective at the chosen cost-effectiveness thresholds. The three studies that had a lower probability of cost-effectiveness were the comparisons from Afghanistan and Ethiopia that were not cost-effective in the base case analysis in addition to the comparison from Ethiopia from the same study that was cost-effective in the base case analysis but only had 50% of the PSA iterations below the cost-effectiveness threshold [ 19 ]. The ICERs in all three of these comparisons were most influenced by parameters related to severe events (from both hemolysis and malaria recurrences), the cost of the G6PD RDT, and how adherent patients were to primaquine. Furthermore, the PSA showed that nearly all model iterations averted DALYs, indicating that the higher ICERs were driven by the increased costs of G6PD screening. The three studies that had a lower probability of cost-effectiveness were the comparisons from Afghanistan and Ethiopia that were not cost-effective in the base case analysis in addition to the comparison from Ethiopia from the same study that was cost-effective in the base case analysis but only had 50% of the PSA iterations below the cost-effectiveness threshold [ 19 ]. The ICERs in all three of these comparisons were most influenced by parameters related to severe events (from both hemolysis and malaria recurrences), the cost of the G6PD RDT, and adherence to primaquine. Table 8 Cost-effectiveness results for studies that compared semi-quantitative glucose-6-phosphate dehydrogenase (G6PD) screening before radical cure with radical cure without G6PD screening in reported currency and 2023 United States dollars (US $ ) from the healthcare provider perspective. Incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year (DALY) averted unless otherwise noted. Location [reference]; time horizon Comparators (current practice in bold text) ICER in reported currency Cost-effectiveness threshold † Probability of being cost-effective at the threshold ICER in 2023 US $ Laos [ 20 ]; 1 year • PQ8W (6mg/kg) unsupervised • SD Biosensor; PQ14 (3.5mg/kg) unsupervised for males testing ≥ 30% and females testing ≥ 70%, PQ8W unsupervised for males testing < 30% and females testing < 70% 2020 US $ 97 2354 (1 GDP/ capita) 81% 112 Laos [ 20 ]; 1 year • PQ8W (6mg/kg) unsupervised • SD Biosensor; PQ14 (3.5mg/kg) with supervision for males testing ≥ 30% and females testing ≥ 70%, PQ8W with supervision for males testing < 30% and females testing < 70% 2020 US $ 185 2354 (1 GDP/ capita) 76% 215 Brazil [ 17 ]; Follows patients to end of hospitalization • PQ7 (3.5mg/kg) • SD Biosensor; PQ7 for patients testing ≥ 30%, PQ8W (6mg/kg) for patients testing < 30% 2020 US $ 495 per PQ-associated hospitalization avoided 6822 (1 GDP/ capita) 100% at values of 2020 US $ 1050 and higher 575 Brazil [ 16 ]; 10 years • PQ7 (3.5mg/kg) • SD Biosensor; TQ (300mg) for adults > 16 years old testing > 70%, PQ7 for adults testing 30–70% with adherence of 66.7% 2020 US $ 982 7800 (CONITEC threshold) 100% 1140 Brazil [ 16 ]; 10 years • PQ7 (3.5mg/kg) • SD Biosensor; TQ (300mg) for all patients > 2 years old testing > 70%, PQ7 for patients testing 30–70% with adherence of 66.7% 2020 US $ 472 7800 (CONITEC threshold) 100% 548 Brazil [ 16 ]; 10 years • PQ7 (3.5mg/kg) • SD Biosensor; TQ (300mg) for adults > 16 years old testing > 70%, PQ7 for adults testing 30–70% with adherence of 90% 2020 US $ 1,836 7800 (CONITEC threshold) 100% 2131 Brazil [ 16 ]; 10 years • PQ7 (3.5mg/kg) • SD Biosensor; TQ (300mg) for adults > 16 years old testing > 70%, PQ7 for adults testing 30–70% with adherence of 30% 2020 US $ 154 7800 (CONITEC threshold) 100% 179 Brazil [ 14 ]; 1 year • PQ7 (3.5mg/kg) for adults • SD Biosensor; TQ (300mg) for adults testing ≥ 70%, PQ7 for adults testing 30–70%, & PQ8W (6mg/kg) for adults testing < 30% 2020 US $ 2894 7752 (CONITEC threshold) 98% 3359 G6PDd = glucose-6-phosphate dehydrogenase; G6PDn = glucose-6-phosphate dehydrogenase normal; GDP = gross domestic product; kg = kilogram; mg = milligram; PQ14 = 14-day primaquine; PQ7 = 7-day primaquine; PQ8W = weekly primaquine for 8 weeks; TQ = tafenoquine † As reported in the study. Cost-effectiveness of two different strategies for G6PD screening before prescription of radical cure Three comparisons looked at the outcome of two different strategies for G6PD screening before prescription of radical cure. All three were conducted for Brazil [ 18 ] The first two comparisons were from the same study, which investigated different qualitative G6PD tests (BinaxNOW verses CareStart) with PQ7 (3.5mg/kg) prescribed to those testing G6PD normal [ 14 , 18 ]. The first comparison used the outcome of ‘cost per adequately diagnosed case’, finding an ICER of US $ 3.9 for CareStart [ 18 ]. The second comparison was used the same comparators but used the outcome of ‘cost per hospitalisation averted’, finding that CareStart dominated BinaxNOW [ 18 ]. Domination in cost-effectiveness means that one intervention (CareStart in this comparison) saved costs while improving health outcomes. In these circumstances, ICERs are not calculated. The final comparison from Peixoto et al . compared PQ7 (3.5mg/kg) for adults testing > 30% and PQ8W (6mg/kg) for adults testing 70%, PQ7 (3.5mg/kg) for adults testing 30–70%, and PQ8W (6mg/kg) for adults testing < 30% [ 14 ]. This study estimated an ICER of 2020 US $ 13 for the strategy with tafenoquine, which was far below the stated threshold of US $ 7752. Table 9 Cost-effectiveness results for studies that compared two different radical cure strategies with glucose-6-phosphate dehydrogenase (G6PD) screening. The less costly comparator is listed first. None of the comparators listed were current practice. Incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year (DALY) averted from the healthcare provider perspective unless otherwise noted. Location [reference]; time horizon Comparators ICER in reported currency Cost-effectiveness threshold † Probability of being cost-effective at the threshold ICER in 2023 US $ Brazil [ 18 ]; Follows male patients to end of malaria episode • BinaxNOW for municipalities with > 100,000 inhabitants; PQ7* for G6PDn & no radical cure for G6PDd • CareStart for 100% of municipalities; PQ7* for G6PDn & no radical cure for G6PDd 2013 US $ 3.0 per adequately diagnosed case 6480 (1 GDP per capita for the Amazon region) Not stated 3.9 Brazil [ 18 ]; Follows male patients to end of hospitalization • CareStart for 100% of municipalities + PQ7* for G6PDn & no radical cure for G6PDd • BinaxNOW for municipalities with > 100,000 inhabitants; PQ7* for G6PDn & no radical cure for G6PDd CareStart dominant with cost savings of 2013 US $ 0.1 and 0.0010 hospitalizations averted 6480 (1 GDP per capita for the Amazon region) Not stated 0.2 Brazil [ 14 ]; 1 year • SD Biosensor; PQ7 (3.5mg/kg) for adults testing > 30% & PQ8W (6mg/kg) for adults testing < 30% • SD Biosensor; TQ (300mg) for adults testing ≥ 70%, PQ7 for adults testing 30–70%, & PQ8W (6mg/kg) for adults testing < 30% 2020 US $ 13 7752 (CONITEC threshold) 98.3% 15 G6PDd = glucose-6-phosphate dehydrogenase; G6PDn = glucose-6-phosphate dehydrogenase normal; GDP = gross domestic product; kg = kilogram; mg = milligram; PQ14 = 14-day primaquine; PQ7 = 7-day primaquine; PQ8W = 8-weekly doses of primaquine; TQ = tafenoquine † As reported in the study. * While dose is not explicitly stated, 3.5mg/kg is used in Brazil. DISCUSSION This review identified seven model-based studies with 16 cost-effectiveness comparisons using two qualitative tests and one semi-quantitative test. The heterogeneity in comparators and settings across these studies presents a challenge to synthesize the cost-effectiveness, but the majority indicated that near-patient screening had a high likelihood of cost-effectiveness. The reported costs per person with qualitative G6PD screening ranged from roughly US $ 1–16. While only one study reported the cost per person screened with a quantitative G6PD test (US $ 15) [ 17 ], the SD Biosensor analyser cost was wide-ranging from US $ 171–832 and the test strips ranged from US $ 5–10. The majority of the 16 comparisons were conducted in Brazil, limiting the generalizability of the results. Two of the papers from Brazil used the same cost and DALY parameter values using different model structures, enabling the comparison of the cost-effectiveness of G6PD screening before the prescription of tafenoquine to adults in Brazil with and without accounting for onward transmission of vivax malaria [ 14 , 16 ]. The transmission model, which was implemented over a 10 year time horizon, had an ICER of US $ 1140 [ 16 ], which was roughly one-third of the ICER of US $ 3359 estimated with the decision tree with a one year time horizon that did not include transmission [ 14 ]. Two studies included the cost of supervised primaquine therapy to ensure adherence. Supervision cost $ 21.71 (2014 US $ ) per person in Thailand [ 21 ] and $ 75 (2020 US $ ) per facility in Laos [ 20 ]. If these costs had not been included, these options would have cost less (making it more cost-effective) while decreasing the effectiveness of primaquine (making it less cost-effective). Accordingly, the overall impact of their inclusion on the results are unknown. The cost of using the SD Biosensor remains uncertain due to not knowing how long the analysers will last in the field. Furthermore, a wide range of unit costs for the analyser were used (US $ 148–717); these prices are likely to change as countries negotiate contracts and scale up screening. Only one comparison looked at the SD Biosensor outside of Brazil [ 20 ], hence future research should explore the cost-effectiveness of this G6PD test in other endemic settings, particularly high burden countries, such as India, Pakistan, and Venezuela. The X-linked nature of G6PD deficiency adds further complexity (and uncertainty) to these models. It is also worth noting that there can be much heterogeneity within a country in addition to the heterogeneity between countries due to the epidemiology of both G6PD deficiency and P. vivax , the remoteness of the district or province, and the ease of logistics and infrastructure. Future cost-effectiveness studies should aim to standardize the costs included in G6PD screening, such as quality assurance and annual healthcare worker training. Furthermore, reporting of the cost per person screened when conducting semi-quantitative G6PD testing would be helpful to include as well as the cost of the analyser and test strips, along with other assumptions like throughputs that are needed to calculate the cost per person screened. Few countries have negotiated prices for G6PD tests; hence, it is unclear how well these costs will reflect the true cost of implementation. The recent volume guarantee agreement for G6PD testing will allow eligible countries access at significantly reduced Ex Works prices: $ 300 for the analyser, $ 3.27 for the test strip, and $ 30 per control kit [ 32 ]. This development should add more certainty to future cost-effectiveness analyses, though the costs of shipping, customs, storage, training, and any other distribution costs will need to be considered for each location. Finally, countries will need to consider at what level of the healthcare system, G6PD screening is implemented, and whether patients or samples would need to travel to a higher level when presenting at a location where G6PD screening is not available. Models are only as good as the data used to determine the parameter values. Given the scarcity of data around parameter values which often have a large impact on results, such as the risk of hemolysis if G6PD deficient patients are prescribed radical cure, it can be challenging to ascertain how well the model results reflect reality. CONCLUSIONS This is the first review to examine the cost-effectiveness of near-patient G6PD screening before the prescription of radical cure for P. vivax patients. Despite much heterogeneity in the study settings and reporting, the reviewed evidence suggests that using near-patient G6PD tests before treatment with radical cure of vivax malaria was cost-effective in most of the included comparisons. This evidence-base was used by the WHO in their recently published guidelines on use of near patient G6PD testing to support radical cure [ 9 ]. Abbreviations DALY disability-adjusted life-year G6PD glucose-6-phosphate dehydrogenase G6PDd glucose-6-phosphate dehydrogenase deficiency ICER incremental cost-effectiveness ratio RDT rapid diagnostic test WHO World Health Organization Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interest The author was a member of the WHO Guideline Development Group meeting for Malaria Diagnostics: near-patient G6PD tests to support radical cure of Plasmodium vivax . Funding AD is funded by an Australian National Health and Medical Research Council of Australia (NHMRC) Investigator Grant (2025362), the Australian Centre of Research Excellence in Malaria Elimination Grant (2024622). Authors’ contributions AD designed the study, extracted and analysed the data, and drafted the manuscript. 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PLoS Med. 2021;18:e1003535. G6PD testing. [ https://medaccess.org/our-agreements/agreements/g6pd-testing/] Additional Declarations Competing interest reported. The author was a member of the WHO Guideline Development Group meeting for Malaria Diagnostics: near-patient G6PD tests to support radical cure of Plasmodium vivax. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 12 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 20 Dec, 2025 Submission checks completed at journal 20 Dec, 2025 First submitted to journal 19 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The author was a member of the WHO Guideline Development Group meeting for Malaria Diagnostics: near-patient G6PD tests to support radical cure of Plasmodium vivax.","formattedTitle":"A review of the cost-effectiveness of using near-patient G6PD tests before treatment with radical cure of vivax malaria","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eWhile the majority of the malaria burden is due to \u003cem\u003ePlasmodium falciparum\u003c/em\u003e, \u003cem\u003eP. vivax\u003c/em\u003e is the most widespread species and more common outside of sub-Saharan Africa [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. \u003cem\u003eP. vivax\u003c/em\u003e is more challenging to control, in part due to recurring malaria episodes called relapses, which are caused by its dormant liver-stage parasites. In order to prevent relapses, liver-stage treatment needs to be prescribed alongside the blood-stage treatment. Together this combination of treatments is called \u0026lsquo;radical cure\u0026rsquo;.\u003c/p\u003e \u003cp\u003eOnly two drugs are currently available to clear the liver-stage parasites. Primaquine is often prescribed either as 7-day or 14-day regimens, requiring patients to continue taking drugs long after symptoms have subsided. Primaquine efficacy is related to the total dose taken, limiting the effectiveness when patients are not adherent to their medications [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Primaquine regimens can either be low-dose (3.5 mg/kg total dose) or high-dose (7 mg/kg total dose), which have both been implemented through 7-day and 14-day regimens. Recent evidence has indicated that high-dose primaquine is more efficacious than low-dose in many settings [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. More recently, tafenoquine has become available as a liver-stage treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Tafenoquine is prescribed as a single dose (300 mg), alleviating the issues around adherence.\u003c/p\u003e \u003cp\u003eBoth primaquine and tafenoquine can cause severe hemolysis in patients with an enzymopathy called glucose-6-phosphate dehydrogenase (G6PD) deficiency, which tends to be more prevalent in \u003cem\u003eP. vivax\u003c/em\u003e endemic settings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. G6PD deficiency is X-linked, meaning that males can be either hemizygous deficient or normal while females can be either homozygous deficient, normal, or heterozygous for the G6PD gene. Tafenoquine is longer acting than primaquine [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and thus requires screening for G6PD deficiency before its prescription. G6PD screening is also recommended when possible before the prescription of primaquine, particularly for the high daily doses of primaquine [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eG6PD tests can be either qualitative (a single threshold at 30% of normal G6PD activity), semi-quantitative (able to also distinguish 30\u0026ndash;70% G6PD activity in G6PD intermediate patients with for moderate G6PD activity), or fully quantitative (able to distinguish a range of activities). Semi-quantitative tests can discriminate three categories of patients: deficient (\u0026lt;\u0026thinsp;30% activity), intermediate (30\u0026ndash;70% activity) and normal (\u0026gt;\u0026thinsp;70% activity). While near-patient screening for G6PD deficiency can enable the safety of radical cure regimens, which will be essential for the control and elimination of malaria, these tests bring additional costs to consider, including quality control and training. It is more challenging to determine the cost per person screened using a semi-quantitative test as compared to qualitative tests because the cost of the analyser needs to be applied at the facility level and is dependent on the number of patients and expected lifetime. This literature review summarizes the previous evidence regarding the cost-effectiveness of near-patient G6PD tests for informing the safe treatment of \u003cem\u003ePlasmodium vivax\u003c/em\u003e.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA systematic search of the available literature was conducted in PubMed in January 2024, including the terms ((g6pd) OR (glucose-6-phosphate dehydrogenase)) AND (cost-effectiveness) AND (vivax). For each study, data on location, G6PD test utilized, placement of screening in the healthcare system (e.g., clinic, hospital), prevalence of G6PD deficiency, probability of hemolysis, perspective for the analysis, and model assumptions, including adherence to primaquine regimens were extracted. The costs and assumptions for training on how to conduct the G6PD screening were also extracted. This was also done for hemolytic events related to treatment. To aid comparability, all costs extracted from the studies were inflated to 2023 US\u003cspan\u003e$\u003c/span\u003e, which were reported alongside the cost year and currency as reported in each included study. Since most of the unit costs for G6PD screening were collected in US\u003cspan\u003e$\u003c/span\u003e, gross domestic product (GDP) deflators for US\u003cspan\u003e$\u003c/span\u003e were used to inflate costs to 2023 US\u003cspan\u003e$\u003c/span\u003e [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor qualitative G6PD tests, the cost of the test and the cost per person screened were extracted. For semi-quantitative G6PD tests, the cost of the analyser, the test strip, batteries for the analyser, and quality assurance were extracted. In addition to the unit costs for the aforementioned items, the analyser cost per person screened is dependent on how long the analyser lasts before needing to be replaced (lifetime), the number of patients screened per year, and the discount rate. The discount rate is the amount that future costs are reduced, reflecting that people would prefer to have money now rather than in future years. A higher discount rate results in less value being attached to costs in the future. For example, a discount rate of 3.5% will result in \u003cspan\u003e$\u003c/span\u003e10 spent in Year 2 having a present value of \u003cspan\u003e$\u003c/span\u003e9.66 while a discount rate of 5% will result in the present value lowering to \u003cspan\u003e$\u003c/span\u003e9.52. Discount rates used in the analyses were also reported.\u003c/p\u003e \u003cp\u003eThe main outcome for cost-effectiveness analyses is called the incremental cost-effectiveness ratio (ICER). It is calculated by dividing the difference between the costs of two alternatives by the difference between their health outcomes. ICERs are interpreted as cost-effective if the values for a new intervention are below the cost-effectiveness threshold, which is pre-specified before conducting the analysis. While some countries have set cost-effectiveness thresholds to inform decision making, many do not.\u003c/p\u003e \u003cp\u003eThe health outcomes used in economic evaluations include disability-adjusted life-years (DALYs) and natural units. DALYs are a health outcome that captures both years of life lost and years of life with disability, enabling comparisons across different diseases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The goal is to minimise DALYs. One-half to one GDP per capita per DALY averted is commonly used as the cost-effectiveness threshold for settings where a threshold has not been stated explicitly and thresholds based on opportunity costs are not available [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The use of DALYs enables the comparison with other disease programs (e.g., cancer). The use of natural units can include outcomes such as malaria cases averted, hospitalizations averted, and adequately diagnosed case. While these are not comparable with other diseases, they can be useful for decision making within the malaria control program. It is, however, unclear what an appropriate threshold would be for ICERs that use natural units as their outcomes, and these are likely to be context specific.\u003c/p\u003e \u003cp\u003eIn addition to the base case results, economic evaluations typically include one-way sensitivity analysis and probabilistic sensitivity analysis (PSA). A one-way sensitivity analysis is when an individual model parameter is varied to higher and lower values to see the impact of that parameter on the ICER. In contrast, a distribution is put around each model parameter for a PSA, and these are sampled at the same time for a number of model runs (often\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;1,000) to capture uncertainty across all model parameters. The results are used to construct a cost-effectiveness acceptability curve, which presents the percentage of model runs that had an ICER below the pre-specified cost-effectiveness threshold. The reported cost-effectiveness threshold and percentage of model runs below that threshold were extracted for each comparison.\u003c/p\u003e \u003cp\u003eSince many papers reported the results for multiple countries and comparators, each comparison was extracted separately for the cost-effectiveness results. For each comparison, the time horizon, radical cure regimen(s) used, the ICER in reported currency, cost-effectiveness threshold, and probability of being cost-effective were extracted. All listed doses of primaquine and tafenoquine are the total dose prescribed. For each comparator using a qualitative test, the G6PD activity cut-offs used for each treatment strategy were also included. To aid comparability, results were presented in the following groups based on the comparators in each analysis:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eG6PD screening before radical cure compared with no radical cure\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQualitative G6PD screening before radical cure compared with radical cure without G6PD screening\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSemi-quantitative G6PD screening before radical cure compared with radical cure without G6PD screening\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTwo strategies with G6PD screening before radical cure.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAs with the unit costs, ICERs were inflated to 2023 US\u003cspan\u003e$\u003c/span\u003e to aid comparability across results.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSix peer-reviewed studies were identified. An additional study by Peixoto \u003cem\u003eet al\u003c/em\u003e. that had not been peer-reviewed at the time of this review was added to the results [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; this work was submitted to the health technology assessment body, Brazilian National Commission for the Incorporation of Technology in the SUS (\u003cem\u003eComiss\u0026atilde;o Nacional de Incorpora\u0026ccedil;\u0026atilde;o de Tecnologias no Sistema \u0026Uacute;nico de Sa\u0026uacute;de\u003c/em\u003e [CONITEC]) in 2023 as part of the approval process for G6PD screening before the prescription of tafenoquine and was published online in Portuguese [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. When including the most recent Peixoto \u003cem\u003eet al\u003c/em\u003e. study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], the seven studies were published between 2016 and 2025; all took the healthcare provider perspective for defining the scope of the costs and benefits included in the primary analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All studies reported costs in US\u003cspan\u003e$\u003c/span\u003e with cost years ranging from 2013 to 2020.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics and epidemiological parameters as described by the included cost-effectiveness studies. Studies are listed in chronological order.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG6PDd prevalence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG6PD test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePlacement of screening\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProbability of hemolysis for G6PDd prescribed radical cure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePerspective\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReferences \u0026amp; notes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeixoto (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5% for males;\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cem\u003eFemales were not included in the analysis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; BinaxNOW for municipalities with \u0026gt;\u0026thinsp;100,000 inhabitants\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart for 100% of municipalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot explicitly stated but all patients with \u003cem\u003eP. vivax\u003c/em\u003e were screened, implying all levels of the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94.3% hospitalized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Operational limitations related to the required temperature control and venous blood collection currently restrict the use of Binax NOW in small municipalities. One comparison for each G6PD test: these tests were not implemented concurrently. PQ adherence not considered.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevine (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThai-Myanmar border\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.7% for males;\u003c/p\u003e \u003cp\u003e5.0% for female; 15.8% for intermediate females\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eClinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11% need a blood transfusion if severe G6PD (0.5% if intermediate); 10% of those in need don\u0026rsquo;t receive a transfusion; 10% of those who don\u0026rsquo;t receive a transfusion die\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Included costs for the supervision of PQ so adherence was assumed to be 100%.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDevine (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfghanistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0% for males;\u003c/p\u003e \u003cp\u003e4.0% for females\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLocal clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e11% need a blood transfusion; 10% don\u0026rsquo;t receive a transfusion; 10% of those who don\u0026rsquo;t receive a transfusion die\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealthcare provider \u0026amp; societal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Adherence was 62% for PQ7; 47% for PQ14; 31% for PQ8W. The analyses included 3 options for females: 1) PQ14 (3.5mg/kg total); 2) PQ7 (7.0mg/kg total); 3) referral to a higher facility for semi-quantitative G6PD screening \u0026amp; TQ if\u0026thinsp;\u0026gt;\u0026thinsp;70% activity. The results for PQ14 and referral to a higher facility for TQ were consistently dominated by PQ7 so not presented below.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0% for males;\u003c/p\u003e \u003cp\u003e1.0% for females\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndonesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0% for males;\u003c/p\u003e \u003cp\u003e4.0% for females\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVietnam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0% for males;\u003c/p\u003e \u003cp\u003e3.0% for females\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAung (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.0% of males had\u0026thinsp;\u0026lt;\u0026thinsp;30% G6PD activity;\u003c/p\u003e \u003cp\u003e13.0% of females had\u0026thinsp;\u0026lt;\u0026thinsp;70% G6PD activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD Biosensor STANDARD test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealth center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13% hemolyze; 10% don't go to hospital; 10% of those who don't go to hospital die\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Adherence assumed to be 100% for all supervised regimens; 85% for unsupervised PQ14; 43% for unsupervised PQ8W. While supervised PQ14 (3.5mg/kg total) without G6PD screening was also included as a comparator, it was dominated so not presented below.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrito-Sousa (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5% for males; 2.5% for females\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD Biosensor STANDARD test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot explicitly stated but all patients with \u003cem\u003eP. vivax\u003c/em\u003e were screened, implying all levels of the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13% hospitalized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrice (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG6PDd varied by province\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD Biosensor STANDARD test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot explicitly stated but all patients with \u003cem\u003eP. vivax\u003c/em\u003e were screened, implying all levels of the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8% hemolyze if severe G6PDd (3.1% if intermediate G6PDd);\u003c/p\u003e \u003cp\u003e11% of those die\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Results are discounted by 5%. PQ7 adherence varied from 30\u0026ndash;90% depending on the analysis. PQ8W was considered not effective so was not included [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. G6PD activity score distribution was based on Markov chain Monte Carlo fitted Gaussian mixture models to 4 datasets (see also [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]). For 2 states in which survey data were not available a national-level prevalence of 5.52% G6PD deficiency was used.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeixoto (2025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6% for males;\u003c/p\u003e \u003cp\u003e0.3% for female; 10.6% for intermediate female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD Biosensor STANDARD test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot explicitly stated but all patients with \u003cem\u003eP. vivax\u003c/em\u003e were screened, implying all levels of the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8% hemolyze if severe G6PDd (3.1% if intermediate G6PDd);\u003c/p\u003e \u003cp\u003e11% of those die\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] While this work has not yet been peer reviewed, the results were published in Portuguese in the CONITEC report that enabled tafenoquine to be prescribed in Brazil [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. PQ adherence was 67%.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eCONITEC\u0026thinsp;=\u0026thinsp;Brazilian National Commission for the Incorporation of Technology in the SUS (\u003cem\u003eComiss\u0026atilde;o Nacional de Incorpora\u0026ccedil;\u0026atilde;o de Tecnologias no Sistema \u0026Uacute;nico de Sa\u0026uacute;de\u003c/em\u003e); G6PD\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase; G6PDd\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase deficiency; PQ14\u0026thinsp;=\u0026thinsp;14-day primaquine; PQ7\u0026thinsp;=\u0026thinsp;7-day primaquine; PQ8W\u0026thinsp;=\u0026thinsp;weekly primaquine for 8 weeks; TQ\u0026thinsp;=\u0026thinsp;tafenoquine\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll studies used a model for their evaluations with a decision tree structure, except one study that used a transmission model coupled with an economic model [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Some studies involved multiple countries while others had multiple comparisons for the cost-effectiveness analyses. Four studies were set in Brazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] with the remaining three studies presented results for six other countries: Afghanistan [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Ethiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Indonesia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Laos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Thailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and Vietnam [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Three G6PD tests were evaluated: the qualitative CareStart\u0026trade; G6PD rapid diagnostic tests (RDT)) by AccessBio [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], the qualitative BinaxNOW\u0026trade; G6PD Test by Abbott [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and the semi-quantitative test STANDARD\u0026trade; G6PD by SD Biosensor [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e describes the key assumptions for each study included in the review. There was a high level of heterogeneity amongst the studies regarding the prevalence of G6PD deficiency (1-13.7%), the risk of hemolysis to G6PD deficient patients prescribed radical cure (3.8\u0026ndash;94.3% hospitalized), which costs were included (e.g., staff training, quality assurance), and the comparators selected for the analyses. Assumptions regarding the prevalence of G6PD deficiency and probability of severe hemolysis can have a large impact on cost-effectiveness [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eTraining costs\u003c/h3\u003e\n\u003cp\u003eWhile not all studies reported the training costs required to educate healthcare workers on how to administer G6PD testing, the four most recent studies all included these costs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For the four studies where it was possible to make the calculations, the training cost ranged from US\u003cspan\u003e$\u003c/span\u003e 0.42 to US\u003cspan\u003e$\u003c/span\u003e 29.07 per person screened for G6PD deficiency (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The largest cost estimate was from Laos, which reported both the highest cost per facility trained (US\u003cspan\u003e$\u003c/span\u003e 407) and the lowest patient throughput (14 patients per year) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. One additional study estimated a cost of US\u003cspan\u003e$\u003c/span\u003e 135 per year but did not report the average throughput per facility [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCosts for training on the administration of glucose-6-phosphate dehydrogenase tests.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation [reference]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG6PD test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2024 US\u003cspan\u003e$\u003c/span\u003e per person\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBinaxNOW \u0026amp; CareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e 0.80/patient screened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot included\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfghanistan, Ethiopia, Indonesia \u0026amp; Vietnam [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot included\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD Biosensor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 351/facility/year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.07*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD Biosensor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 0.36/patient screened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD Biosensor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 58/healthcare worker/year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135/facility/year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD Biosensor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 58/healthcare worker/year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.45\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUS\u003cspan\u003e$\u003c/span\u003e: United States dollars.\u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003e Unless otherwise stated.\u003c/p\u003e \u003cp\u003e* 14 patients per healthcare facility per year.\u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e 55 patients per healthcare facility per year and 2 healthcare workers per facility.\u003c/p\u003e\n\u003ch3\u003eHemolytic event costs\u003c/h3\u003e\n\u003cp\u003eThe cost per hemolytic event ranged from US\u003cspan\u003e$\u003c/span\u003e 49 in Ethiopia to US\u003cspan\u003e$\u003c/span\u003e 407 in Thailand. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e) The majority of costs (60%, 6/10) took a 7-day inpatient stay from WHO-CHOICE unit cost estimates [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and added the cost of a unit of blood from a working paper on the unit costs of healthcare inputs in LMICs [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The remaining four studies from Brazil ranged in cost from US\u003cspan\u003e$\u003c/span\u003e 87 to US\u003cspan\u003e$\u003c/span\u003e 283, reflecting the range of sources and methods used to estimate them.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHemolytic event costs in reported currency and 2023 United States dollars (US\u003cspan\u003e$\u003c/span\u003e) along with assumptions and original sources for unit costs where available.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation [reference]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssumptions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e 283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncludes pre-admission tests, medical appointments, hospital food, and hospitalization costs. Hospitalization costs were obtained from 108 patient files from the Hospital Information System (SIH/SUS) of the Brazilian Amazon in 2013.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014 US\u003cspan\u003e$\u003c/span\u003e 321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOne unit of blood from [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a 7-day inpatient stay from WHO-CHOICE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfghanistan [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOne unit of blood from [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a 7-day inpatient stay from WHO-CHOICE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOne unit of blood from [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a 7-day inpatient stay from WHO-CHOICE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndonesia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOne unit of blood from [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a 7-day inpatient stay from WHO-CHOICE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVietnam [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOne unit of blood from [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a 7-day inpatient stay from WHO-CHOICE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOne unit of blood from [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a 7-day inpatient stay from WHO-CHOICE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-admission tests and hospitalization from [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and medical appointments from [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCost per episode from [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCost per episode from [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eQualitative test costs\u003c/h3\u003e\n\u003cp\u003eOverall, the unit cost of a qualitative G6PD test ranged from US\u003cspan\u003e$\u003c/span\u003e 0.86 in Ethiopia to US\u003cspan\u003e$\u003c/span\u003e 16.13 in Indonesia (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Of the seven unit costs, only one (14%) was for BinaxNOW. Most studies (86%, 6/7) reported the cost per person screened, which included things such as the cost of an additional blood draw and staff time to administer the test. The inclusion of these costs was not consistent across the studies. The resulting cost per person screened ranged from US\u003cspan\u003e$\u003c/span\u003e 2.08 in Vietnam to US\u003cspan\u003e$\u003c/span\u003e 19.09 in Indonesia (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Quality control and training costs did not appear to be included in any study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCosts associated with qualitative glucose-6-phosphate dehydrogenase (G6PD) screening.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLocation [reference]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eReported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG6PD test cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePer person screened\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eG6PD test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePer person screened\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.88 for BinaxNOW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.01: Supplies and staff time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e7.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e11.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.50 for CareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.34: Supplies and staff time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.75 for CareStart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOnly G6PD test cost reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfghanistan [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.72 for CareStart*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.42: Blood draw and staff time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e4.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69 for CareStart*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.56: Blood draw and staff time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e4.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndonesia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.96 for CareStart*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.34: Blood draw and staff time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e16.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e19.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVietnam [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96 for CareStart*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67: Blood draw and staff time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e2.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eUS$ = United States Dollars\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003e Lists items included in addition to the qualitative G6PD test cost.\u003c/p\u003e \u003cp\u003e* Extracted from the original costing study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSemi-quantitative test costs\u003c/h3\u003e\n\u003cp\u003eThe only semi-quantitative point-of-care test studied was the SD Biosensor STANDARD test. Four studies used the SD Biosensor; with one study in Laos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and the other three in Brazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The need for a portable analyser to read the test strips increases the initial cost of rolling out the screening method with the cost per SD Biosensor analyser ranged from US\u003cspan\u003e$\u003c/span\u003e 171 to US\u003cspan\u003e$\u003c/span\u003e 832 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e). While the studies in Brazil gave the analyser a lifetime of five years and a 5% discount rate [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the study in Laos assumed three years and a 3% discount rate [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The SD Biosensor test strip unit cost ranged from US\u003cspan\u003e$\u003c/span\u003e 5.00 in Laos to US\u003cspan\u003e$\u003c/span\u003e 10.13 in Brazil (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Where stated, the patients screened by one analyser ranged from 14 to 68 per year. Quality assurance was reported in a variety of ways: per person screened, per month, per 3 months; and mainly focused on the cost of the controls. Only one study reported the cost per person screened, which was US\u003cspan\u003e$\u003c/span\u003e 14.88 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCosts associated with semi-quantitative glucose-6-phosphate dehydrogenase (G6PD) screening in the review. All used the SD Biosensor STANDARD test. Quality assurance (QA) are annual costs at the facility level unless otherwise stated.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCountry [reference]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiscount rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLifetime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eReported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e \u003cp\u003e2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnalyser\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTest strip\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eQA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePer person screened\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAnalyser\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eTest strip\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eAnnual QA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePer person screened\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e103\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eCosts were calculated at the facility level with each facility diagnosing 14 cases/year.\u003c/p\u003e \u003cp\u003eAssumed an 8-month shelf life per box of test strips, resulting in a minimum of 37 strips/ facility/year. This would cover the strips needed for QA costs, which accordingly did not include test strip cost. QA was 22 every 3 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.113 per person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e10.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8.92*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eThe per person quality assurance cost assumed US\u003cspan\u003e$\u003c/span\u003e9.50 for controls, which was divided by 20, then multiplied by the average number of controls per analyser in one year (16.22), then divided by the average number of tests per analyser in one year (68). It is not clear if QA included the cost of test strips to run the controls.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eCosts were calculated at the facility level, assuming 1.05 analysers per facility. The number of patients per year was not reported. Included 0.64 for additional blood draw for G6PD screening. QA was US\u003cspan\u003e$\u003c/span\u003e 20 per facility monthly including the cost of one set of controls and 2 test strips to run the controls.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eCosts were calculated at the facility level with 55 patients/facility/year. QA only includes the monthly cost for controls. The cost of two test strips was included separately in the model calculations, making it equivalent in costs to [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Includes 3.3 for blood draw.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUS\u003cspan\u003e$\u003c/span\u003e = United States dollars.\u003c/p\u003e \u003cp\u003e \u003csup\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e \u003c/sup\u003e QA multiplied by 4.\u003c/p\u003e \u003cp\u003e* Per person cost multiplied by 68 patients per year.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCost-effectiveness thresholds\u003c/h2\u003e \u003cp\u003eIn Brazil, the health technology assessment body (CONITEC) has a stated threshold of 40,000 Brazilian reais [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Two of the studies from Brazil used this threshold for DALYs averted [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. One study from Brazil used a threshold of one GDP per capita for the Amazon region was chosen for both natural unit outcomes it reported, implying that an adequately diagnosed case of malaria and a hospitalization averted were each equivalent to one year in perfect health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A subsequent paper used the GDP per capita for Brazil as its threshold, stating that it is commonly used for hospitalizations averted for neglected diseases in Brazil [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. While Thailand has a stated threshold of 160,000 Thai baht [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], a lower threshold was chosen for the analysis in Thailand to reflect the migrant population in that study [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The other countries did not have a stated cost-effectiveness threshold; GDP-based thresholds were used in those analyses. All studies conducted probabilistic sensitivity analysis (PSA), enabling the probability of being cost-effective at the chosen threshold to be extracted.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCost-effectiveness of G6PD screening before radical cure compared to no radical cure\u003c/h3\u003e\n\u003cp\u003eIn total, the seven studies provided 21 comparisons for the cost-effectiveness results. Only two of these looked at G6PD screening before radical cure as compared to no radical cure (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Both used qualitative G6PD tests. In Ethiopia, the ICER was US\u003cspan\u003e$\u003c/span\u003e 580 from the healthcare provider perspective, but this changed to the comparator with G6PD screening dominating no screening when the societal perspective was taken [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This means that G6PD screening improved health outcomes while saving money as compared to no radical cure. The ICER from the healthcare provider perspective was lower than the cost-effectiveness threshold of US\u003cspan\u003e$\u003c/span\u003e 700 with a 50% probability of being cost-effective at that threshold.\u003c/p\u003e \u003cp\u003eThe second study was from the Thai-Myannar border, which resulted in ICERs of US\u003cspan\u003e$\u003c/span\u003e 8.0 for males and US\u003cspan\u003e$\u003c/span\u003e 14.8 for females with the corresponding probabilities of being cost-effective at the cost-effectiveness threshold of US\u003cspan\u003e$\u003c/span\u003e 500 of 81% and 78%, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCost-effectiveness results for studies that compared glucose-6-phosphate dehydrogenase (G6PD) screening before radical cure with no radical cure (current practice) in reported currency and 2023 United States dollars (US\u003cspan\u003e$\u003c/span\u003e). For all comparisons, incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year averted. Results are from the healthcare provider perspective unless otherwise specified.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation [reference]; time horizon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG6PD test; radical cure regimen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICER in reported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCost-effectiveness threshold\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProbability of being cost-effective\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICER in 2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCareStart; PQ14 (7mg/kg) for G6PDn, PQ8W (6mg/kg) for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014 US\u003cspan\u003e$\u003c/span\u003e 6.3 for males \u0026amp; 11.7 for females\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81% for males \u0026amp; 78% for females\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.0 for males \u0026amp; 14.8 for females\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 466 (CareStart was dominant with cost savings of 4.6 and 0.0077 DALYs averted from the societal perspective)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e700 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e580 (CareStart was dominant with cost savings of 5.7 from the societal perspective)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eG6PDd\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase; G6PDn\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase normal; GDP\u0026thinsp;=\u0026thinsp;gross domestic product; kg\u0026thinsp;=\u0026thinsp;kilogram; mg\u0026thinsp;=\u0026thinsp;milligram; PQ14\u0026thinsp;=\u0026thinsp;14-day primaquine;PQ7\u0026thinsp;=\u0026thinsp;7-day primaquine; PQ8W\u0026thinsp;=\u0026thinsp;weekly primaquine for 8 weeks ; TQ\u0026thinsp;=\u0026thinsp;tafenoquine\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCost-effectiveness results for studies that compared qualitative glucose-6-phosphate dehydrogenase (G6PD) screening before radical cure with radical cure without G6PD screening in reported currency and 2023 United States dollars (US\u003cspan\u003e$\u003c/span\u003e). Incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year (DALY) averted from the healthcare provider perspective unless otherwise noted.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation [reference]; time horizon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparators (current practice in bold text when included)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICER in reported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCost-effectiveness threshold\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProbability of being cost-effective at the threshold\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICER in 2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Follows male patients to end of malaria episode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; BinaxNOW in municipalities with \u0026gt;\u0026thinsp;100,000 inhabitants; PQ7 for G6PDn, no radical cure for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e 10.0 per adequately diagnosed case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6480 (1 GDP per capita for the Amazon region)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot stated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.9 per adequately diagnosed case\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Follows male patients to end of hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; BinaxNOW in municipalities with \u0026gt;\u0026thinsp;100,000 inhabitants; PQ7 for G6PDn \u0026amp; no radical cure for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e 63.9 per hospitalization averted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6480 (1 GDP per capita for the Amazon region)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot stated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.5 per hospitalization averted\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Follows male patients to end of malaria episode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7\u003c/b\u003e*\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart in 100% of municipalities; PQ7 for G6PDn, no radical cure for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e 4.3 per adequately diagnosed case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6480 (1 GDP per capita for the Amazon region)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot stated but appears to be ~\u0026thinsp;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.5 per adequately diagnosed case\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Follows male patients to end of hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7\u003c/b\u003e*\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart in 100% of municipalities; PQ7 for G6PDn, no radical cure for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCareStart was dominant with cost savings of 2013 US\u003cspan\u003e$\u003c/span\u003e 0.1 and 0.0014 hospitalizations averted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6480 (1 GDP per capita for the Amazon region)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot stated but appears to be ~\u0026thinsp;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCareStart was dominant with cost savings of \u003cspan\u003e$\u003c/span\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; PQ14 (7mg/kg)\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart; PQ14 for G6PDn, PQ8W (6mg/kg) for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCareStart was dominant with cost savings of 2014 US\u003cspan\u003e$\u003c/span\u003e 7.1 per male and \u003cspan\u003e$\u003c/span\u003e2.2 per female and 0.011 and 0.004 DALYs averted in males and females, respectively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98% for males.\u003c/p\u003e \u003cp\u003e91% for females\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCareStart was dominant with cost savings of 9.0 per male and 2.8 per female\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfghanistan [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ14 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 1089 (815 from the societal perspective)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e600 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; 1355\u003c/p\u003e \u003cp\u003e\u0026bull; 1014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndonesia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ14 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 4443 (2028 from the societal perspective)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3600 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; 5530\u003c/p\u003e \u003cp\u003e\u0026bull; 3520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVietnam [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ14 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart; TQ for G6PDn males (300mg), PQ7 for G6PDn females (7mg/kg), PQ8W (6mg/kg) for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016 US\u003cspan\u003e$\u003c/span\u003e 127 (CareStart was dominant with cost savings of 7.9 and 0.0068 DALYs averted from the societal perspective)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2200 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; 158\u003c/p\u003e \u003cp\u003e\u0026bull; From the societal perspective, CareStart was dominant with cost savings of 9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eG6PDd\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase; G6PDn\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase normal; GDP\u0026thinsp;=\u0026thinsp;gross domestic product; kg\u0026thinsp;=\u0026thinsp;kilogram; mg\u0026thinsp;=\u0026thinsp;milligram; PQ14\u0026thinsp;=\u0026thinsp;14-day primaquine; PQ7\u0026thinsp;=\u0026thinsp;7-day primaquine; PQ8W\u0026thinsp;=\u0026thinsp;weekly primaquine for 8 weeks; TQ\u0026thinsp;=\u0026thinsp;tafenoquine\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/sup\u003e As reported in the study.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* While dose is not explicitly stated, 3.5mg/kg is used in Brazil.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e \u003c/sup\u003e As reported in the study.\u003c/p\u003e\n\u003ch3\u003eCost-effectiveness of qualitative G6PD screening before radical cure compared to radical cure without G6PD screening\u003c/h3\u003e\n\u003cp\u003eEight comparisons compared radical cure with and without G6PD screening before prescription. Two of these studies found that G6PD screening would reduce costs while averting DALYs in Brazil and Thailand [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] while an additional study in Vietnam showed domination when the societal perspective was taken [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. For the study from Thailand, the one-way sensitivity analysis found that G6PD screening before primaquine was cost saving for all results except for when the qualitative G6PD test cost was raised to US\u003cspan\u003e$\u003c/span\u003e 10.0, which caused an incremental cost for the screening strategy to 2014 US\u003cspan\u003e$\u003c/span\u003e 235.9 and US\u003cspan\u003e$\u003c/span\u003e 1602.1 for males and females, respectively [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The comparisons in Afghanistan and Indonesia both showed qualitative G6PD screening to be above the specified cost-effectiveness thresholds [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The remaining four comparisons found that G6PD screening would be cost-effective [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results from the PSAs indicated that there was \u0026gt;\u0026thinsp;75% probability that G6PD screening would be cost-effective at the chosen cost-effectiveness thresholds in four comparisons, two comparisons (Afghanistan and Indonesia) had\u0026thinsp;\u0026lt;\u0026thinsp;25% probability of being cost-effective, and two comparisons were not presented. The PSAs for Afghanistan and Indonesia showed that nearly all model iterations averted DALYs, indicating that the higher ICERs were driven by the increased costs of G6PD screening [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCost-effectiveness of semi-quantitative G6PD screening before radical cure compared to radical cure without screening\u003c/h2\u003e \u003cp\u003eEight comparisons evaluated radical cure prescription after semi-quantitative G6PD screening with radical cure prescription without G6PD screening. Only one comparison evaluated the use of the same radical cure regimen (PQ7 3.5mg/kg total dose) for both strategies in Brazil [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The other 5 comparisons in Brazil compared PQ7 (PQ7 3.5mg/kg total dose) without G6PD screening with tafenoquine prescribed after G6PD screening [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The remaining two comparisons were in Laos, comparing PQ8W without screening with supervised and unsupervised PQ14 (both 3.5mg/kg total dose) prescribed after G6PD screening.\u003c/p\u003e \u003cp\u003eWhile two studies used the same unit costs and cost year for Brazil, the comparisons in Price \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] were lower than those in Peixoto \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] due to model structure (Price \u003cem\u003eet al\u003c/em\u003e. includes the impact on transmission while Peixoto \u003cem\u003eet al\u003c/em\u003e does not) and time horizon (1 year for this study as compared to 10 years in Price 2024).\u003c/p\u003e \u003cp\u003eFor 81% (13/16) of the comparisons, the results from the PSAs indicated that there was \u0026gt;\u0026thinsp;75% probability that G6PD screening would be cost-effective at the chosen cost-effectiveness thresholds. The three studies that had a lower probability of cost-effectiveness were the comparisons from Afghanistan and Ethiopia that were not cost-effective in the base case analysis in addition to the comparison from Ethiopia from the same study that was cost-effective in the base case analysis but only had 50% of the PSA iterations below the cost-effectiveness threshold [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The ICERs in all three of these comparisons were most influenced by parameters related to severe events (from both hemolysis and malaria recurrences), the cost of the G6PD RDT, and how adherent patients were to primaquine. Furthermore, the PSA showed that nearly all model iterations averted DALYs, indicating that the higher ICERs were driven by the increased costs of G6PD screening.\u003c/p\u003e \u003cp\u003eThe three studies that had a lower probability of cost-effectiveness were the comparisons from Afghanistan and Ethiopia that were not cost-effective in the base case analysis in addition to the comparison from Ethiopia from the same study that was cost-effective in the base case analysis but only had 50% of the PSA iterations below the cost-effectiveness threshold [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The ICERs in all three of these comparisons were most influenced by parameters related to severe events (from both hemolysis and malaria recurrences), the cost of the G6PD RDT, and adherence to primaquine.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCost-effectiveness results for studies that compared semi-quantitative glucose-6-phosphate dehydrogenase (G6PD) screening before radical cure with radical cure without G6PD screening in reported currency and 2023 United States dollars (US\u003cspan\u003e$\u003c/span\u003e) from the healthcare provider perspective. Incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year (DALY) averted unless otherwise noted.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation [reference]; time horizon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparators (current practice in bold text)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICER in reported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCost-effectiveness threshold\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProbability of being cost-effective at the threshold\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICER in 2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ8W (6mg/kg) unsupervised\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; PQ14 (3.5mg/kg) unsupervised for males testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;30% and females testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;70%, PQ8W unsupervised for males testing\u0026thinsp;\u0026lt;\u0026thinsp;30% and females testing\u0026thinsp;\u0026lt;\u0026thinsp;70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2354 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ8W (6mg/kg) unsupervised\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; PQ14 (3.5mg/kg) with supervision for males testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;30% and females testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;70%, PQ8W with supervision for males testing\u0026thinsp;\u0026lt;\u0026thinsp;30% and females testing\u0026thinsp;\u0026lt;\u0026thinsp;70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2354 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]; Follows patients to end of hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; PQ7 for patients testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;30%, PQ8W (6mg/kg) for patients testing\u0026thinsp;\u0026lt;\u0026thinsp;30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 495 per PQ-associated hospitalization avoided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6822 (1 GDP/ capita)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100% at values of 2020 US\u003cspan\u003e$\u003c/span\u003e 1050 and higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; TQ (300mg) for adults\u0026thinsp;\u0026gt;\u0026thinsp;16 years old testing\u0026thinsp;\u0026gt;\u0026thinsp;70%, PQ7 for adults testing 30\u0026ndash;70% with adherence of 66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7800 (CONITEC threshold)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; TQ (300mg) for all patients\u0026thinsp;\u0026gt;\u0026thinsp;2 years old testing\u0026thinsp;\u0026gt;\u0026thinsp;70%, PQ7 for patients testing 30\u0026ndash;70% with adherence of 66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7800 (CONITEC threshold)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; TQ (300mg) for adults\u0026thinsp;\u0026gt;\u0026thinsp;16 years old testing\u0026thinsp;\u0026gt;\u0026thinsp;70%, PQ7 for adults testing 30\u0026ndash;70% with adherence of 90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 1,836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7800 (CONITEC threshold)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7 (3.5mg/kg)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; TQ (300mg) for adults\u0026thinsp;\u0026gt;\u0026thinsp;16 years old testing\u0026thinsp;\u0026gt;\u0026thinsp;70%, PQ7 for adults testing 30\u0026ndash;70% with adherence of 30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7800 (CONITEC threshold)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePQ7 (3.5mg/kg) for adults\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; TQ (300mg) for adults testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;70%, PQ7 for adults testing 30\u0026ndash;70%, \u0026amp; PQ8W (6mg/kg) for adults testing\u0026thinsp;\u0026lt;\u0026thinsp;30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 2894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7752 (CONITEC threshold)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3359\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eG6PDd\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase; G6PDn\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase normal; GDP\u0026thinsp;=\u0026thinsp;gross domestic product; kg\u0026thinsp;=\u0026thinsp;kilogram; mg\u0026thinsp;=\u0026thinsp;milligram; PQ14\u0026thinsp;=\u0026thinsp;14-day primaquine; PQ7\u0026thinsp;=\u0026thinsp;7-day primaquine; PQ8W\u0026thinsp;=\u0026thinsp;weekly primaquine for 8 weeks; TQ\u0026thinsp;=\u0026thinsp;tafenoquine\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e \u003c/sup\u003e As reported in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCost-effectiveness of two different strategies for G6PD screening before prescription of radical cure\u003c/h2\u003e \u003cp\u003eThree comparisons looked at the outcome of two different strategies for G6PD screening before prescription of radical cure. All three were conducted for Brazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] The first two comparisons were from the same study, which investigated different qualitative G6PD tests (BinaxNOW verses CareStart) with PQ7 (3.5mg/kg) prescribed to those testing G6PD normal [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The first comparison used the outcome of \u0026lsquo;cost per adequately diagnosed case\u0026rsquo;, finding an ICER of US\u003cspan\u003e$\u003c/span\u003e 3.9 for CareStart [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The second comparison was used the same comparators but used the outcome of \u0026lsquo;cost per hospitalisation averted\u0026rsquo;, finding that CareStart dominated BinaxNOW [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Domination in cost-effectiveness means that one intervention (CareStart in this comparison) saved costs while improving health outcomes. In these circumstances, ICERs are not calculated. The final comparison from Peixoto \u003cem\u003eet al\u003c/em\u003e. compared PQ7 (3.5mg/kg) for adults testing\u0026thinsp;\u0026gt;\u0026thinsp;30% and PQ8W (6mg/kg) for adults testing\u0026thinsp;\u0026lt;\u0026thinsp;30% with the SD Biosensor with tafenoquine (300mg) for adults testing\u0026thinsp;\u0026gt;\u0026thinsp;70%, PQ7 (3.5mg/kg) for adults testing 30\u0026ndash;70%, and PQ8W (6mg/kg) for adults testing\u0026thinsp;\u0026lt;\u0026thinsp;30% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study estimated an ICER of 2020 US\u003cspan\u003e$\u003c/span\u003e 13 for the strategy with tafenoquine, which was far below the stated threshold of US\u003cspan\u003e$\u003c/span\u003e 7752.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCost-effectiveness results for studies that compared two different radical cure strategies with glucose-6-phosphate dehydrogenase (G6PD) screening. The less costly comparator is listed first. None of the comparators listed were current practice. Incremental cost-effectiveness ratios (ICERs) are per disability-adjusted life-year (DALY) averted from the healthcare provider perspective unless otherwise noted.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation [reference]; time horizon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICER in reported currency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCost-effectiveness threshold\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProbability of being cost-effective at the threshold\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICER in 2023 US\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Follows male patients to end of malaria episode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; BinaxNOW for municipalities with \u0026gt;\u0026thinsp;100,000 inhabitants; PQ7* for G6PDn \u0026amp; no radical cure for G6PDd\u003c/p\u003e \u003cp\u003e\u0026bull; CareStart for 100% of municipalities; PQ7* for G6PDn \u0026amp; no radical cure for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2013 US\u003cspan\u003e$\u003c/span\u003e 3.0 per adequately diagnosed case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6480 (1 GDP per capita for the Amazon region)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot stated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Follows male patients to end of hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; CareStart for 100% of municipalities\u0026thinsp;+\u0026thinsp;PQ7* for G6PDn \u0026amp; no radical cure for G6PDd\u003c/p\u003e \u003cp\u003e\u0026bull; BinaxNOW for municipalities with \u0026gt;\u0026thinsp;100,000 inhabitants; PQ7* for G6PDn \u0026amp; no radical cure for G6PDd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCareStart dominant with cost savings of 2013 US\u003cspan\u003e$\u003c/span\u003e 0.1 and 0.0010 hospitalizations averted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6480 (1 GDP per capita for the Amazon region)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot stated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; SD Biosensor; PQ7 (3.5mg/kg) for adults testing\u0026thinsp;\u0026gt;\u0026thinsp;30% \u0026amp; PQ8W (6mg/kg) for adults testing\u0026thinsp;\u0026lt;\u0026thinsp;30%\u003c/p\u003e \u003cp\u003e\u0026bull; SD Biosensor; TQ (300mg) for adults testing\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;70%, PQ7 for adults testing 30\u0026ndash;70%, \u0026amp; PQ8W (6mg/kg) for adults testing\u0026thinsp;\u0026lt;\u0026thinsp;30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 US\u003cspan\u003e$\u003c/span\u003e 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7752 (CONITEC threshold)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eG6PDd\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase; G6PDn\u0026thinsp;=\u0026thinsp;glucose-6-phosphate dehydrogenase normal; GDP\u0026thinsp;=\u0026thinsp;gross domestic product; kg\u0026thinsp;=\u0026thinsp;kilogram; mg\u0026thinsp;=\u0026thinsp;milligram; PQ14\u0026thinsp;=\u0026thinsp;14-day primaquine; PQ7\u0026thinsp;=\u0026thinsp;7-day primaquine; PQ8W\u0026thinsp;=\u0026thinsp;8-weekly doses of primaquine; TQ\u0026thinsp;=\u0026thinsp;tafenoquine\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e \u003c/sup\u003e As reported in the study.\u003c/p\u003e \u003cp\u003e* While dose is not explicitly stated, 3.5mg/kg is used in Brazil.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis review identified seven model-based studies with 16 cost-effectiveness comparisons using two qualitative tests and one semi-quantitative test. The heterogeneity in comparators and settings across these studies presents a challenge to synthesize the cost-effectiveness, but the majority indicated that near-patient screening had a high likelihood of cost-effectiveness. The reported costs per person with qualitative G6PD screening ranged from roughly US\u003cspan\u003e$\u003c/span\u003e 1\u0026ndash;16. While only one study reported the cost per person screened with a quantitative G6PD test (US\u003cspan\u003e$\u003c/span\u003e 15) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the SD Biosensor analyser cost was wide-ranging from US\u003cspan\u003e$\u003c/span\u003e 171\u0026ndash;832 and the test strips ranged from US\u003cspan\u003e$\u003c/span\u003e 5\u0026ndash;10.\u003c/p\u003e \u003cp\u003eThe majority of the 16 comparisons were conducted in Brazil, limiting the generalizability of the results. Two of the papers from Brazil used the same cost and DALY parameter values using different model structures, enabling the comparison of the cost-effectiveness of G6PD screening before the prescription of tafenoquine to adults in Brazil with and without accounting for onward transmission of vivax malaria [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The transmission model, which was implemented over a 10 year time horizon, had an ICER of US\u003cspan\u003e$\u003c/span\u003e 1140 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which was roughly one-third of the ICER of US\u003cspan\u003e$\u003c/span\u003e 3359 estimated with the decision tree with a one year time horizon that did not include transmission [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo studies included the cost of supervised primaquine therapy to ensure adherence. Supervision cost\u003c/p\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e21.71 (2014 US\u003cspan\u003e$\u003c/span\u003e) per person in Thailand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and \u003cspan\u003e$\u003c/span\u003e75 (2020 US\u003cspan\u003e$\u003c/span\u003e) per facility in Laos [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. If these costs had not been included, these options would have cost less (making it more cost-effective) while decreasing the effectiveness of primaquine (making it less cost-effective). Accordingly, the overall impact of their inclusion on the results are unknown.\u003c/p\u003e \u003cp\u003eThe cost of using the SD Biosensor remains uncertain due to not knowing how long the analysers will last in the field. Furthermore, a wide range of unit costs for the analyser were used (US\u003cspan\u003e$\u003c/span\u003e148\u0026ndash;717); these prices are likely to change as countries negotiate contracts and scale up screening. Only one comparison looked at the SD Biosensor outside of Brazil [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], hence future research should explore the cost-effectiveness of this G6PD test in other endemic settings, particularly high burden countries, such as India, Pakistan, and Venezuela. The X-linked nature of G6PD deficiency adds further complexity (and uncertainty) to these models. It is also worth noting that there can be much heterogeneity within a country in addition to the heterogeneity between countries due to the epidemiology of both G6PD deficiency and \u003cem\u003eP. vivax\u003c/em\u003e, the remoteness of the district or province, and the ease of logistics and infrastructure.\u003c/p\u003e \u003cp\u003eFuture cost-effectiveness studies should aim to standardize the costs included in G6PD screening, such as quality assurance and annual healthcare worker training. Furthermore, reporting of the cost per person screened when conducting semi-quantitative G6PD testing would be helpful to include as well as the cost of the analyser and test strips, along with other assumptions like throughputs that are needed to calculate the cost per person screened. Few countries have negotiated prices for G6PD tests; hence, it is unclear how well these costs will reflect the true cost of implementation. The recent volume guarantee agreement for G6PD testing will allow eligible countries access at significantly reduced Ex Works prices: \u003cspan\u003e$\u003c/span\u003e300 for the analyser, \u003cspan\u003e$\u003c/span\u003e3.27 for the test strip, and \u003cspan\u003e$\u003c/span\u003e30 per control kit [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This development should add more certainty to future cost-effectiveness analyses, though the costs of shipping, customs, storage, training, and any other distribution costs will need to be considered for each location. Finally, countries will need to consider at what level of the healthcare system, G6PD screening is implemented, and whether patients or samples would need to travel to a higher level when presenting at a location where G6PD screening is not available.\u003c/p\u003e \u003cp\u003eModels are only as good as the data used to determine the parameter values. Given the scarcity of data around parameter values which often have a large impact on results, such as the risk of hemolysis if G6PD deficient patients are prescribed radical cure, it can be challenging to ascertain how well the model results reflect reality.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis is the first review to examine the cost-effectiveness of near-patient G6PD screening before the prescription of radical cure for \u003cem\u003eP. vivax\u003c/em\u003e patients. Despite much heterogeneity in the study settings and reporting, the reviewed evidence suggests that using near-patient G6PD tests before treatment with radical cure of vivax malaria was cost-effective in most of the included comparisons. This evidence-base was used by the WHO in their recently published guidelines on use of near patient G6PD testing to support radical cure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDALY\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edisability-adjusted life-year\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eG6PD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eglucose-6-phosphate dehydrogenase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eG6PDd\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eglucose-6-phosphate dehydrogenase deficiency\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICER\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eincremental cost-effectiveness ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erapid diagnostic test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author was a member of the WHO Guideline Development Group meeting for Malaria Diagnostics: near-patient G6PD tests to support radical cure of \u003cem\u003ePlasmodium vivax\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAD is funded by an Australian National Health and Medical Research Council of Australia (NHMRC) Investigator Grant (2025362), the Australian Centre of Research Excellence in Malaria Elimination Grant (2024622).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAD designed the study, extracted and analysed the data, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to thank Rosalind Howes, Ari \u0026nbsp;Satyagrapha, Jane Cunningham, and Ric Price for their comments on this review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World malaria report 2024. Geneva2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowes RE, Battle KE, Satyagraha AW, Baird JK, Hay SI. G6PD deficiency: global distribution, genetic variants and primaquine therapy. Adv Parasitol. 2013;81:133\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowes RE, Piel FB, Patil AP, Nyangiri OA, Gething PW, Dewi M, Hogg MM, Battle KE, Padilla CD, Baird JK, Hay SI. G6PD deficiency prevalence and estimates of affected populations in malaria endemic countries: a geostatistical model-based map. PLoS Med. 2012;9:e1001339.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThriemer K, Bobogare A, Ley B, Gudo CS, Alam MS, Anstey NM, Ashley E, Baird JK, Gryseels C, Jambert E, et al. Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group. 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Bras\u0026iacute;lia, DF. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.br/conitec/pt-br/midias/pdf/2022/20221106_relatorio-uso-de-limiares-de-custo-efetividade-nas-decisoes-em-saude.pdf\u003c/span\u003e\u003cspan address=\"https://www.gov.br/conitec/pt-br/midias/pdf/2022/20221106_relatorio-uso-de-limiares-de-custo-efetividade-nas-decisoes-em-saude.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsaranuwatchai W, Wang Y, Soboon B, Tungsanga K, Nakamura R, Wee H-L, Botwright S, Theantawee W, Laoharuangchaiyot J, Mongkolchaipak T, et al. An empirical study looking at the potential impact of increasing cost-effectiveness threshold on reimbursement decisions in Thailand. Health Policy Technol. 2024;13:100927.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNekkab N, Lana R, Lacerda M, Obadia T, Siqueira A, Monteiro W, Villela D, Mueller I, White M. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLoS Med. 2021;18:e1003535.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG6PD testing. [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://medaccess.org/our-agreements/agreements/g6pd-testing/]\u003c/span\u003e\u003cspan address=\"https://medaccess.org/our-agreements/agreements/g6pd-testing/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vivax malaria, G6PD deficiency, screening, costs, cost-effectiveness","lastPublishedDoi":"10.21203/rs.3.rs-8409096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8409096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCurrently, primaquine and tafenoquine are the only available drugs to kill the dormant liver-stage parasites of \u003cem\u003ePlasmodium vivax\u003c/em\u003e and \u003cem\u003eP. ovale spp\u003c/em\u003e. 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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\u003cspan\u003e$\u003c/span\u003e) to aid comparability across results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeven model-based studies reporting 16 cost-effectiveness comparisons were identified, including two qualitative tests (AccessBio\u0026rsquo;s CareStart\u0026trade; G6PD Rapid Diagnostic Test and Abbott\u0026rsquo;s BinaxNOW\u0026trade; G6PD Test) and one semi-quantitative test (SD Biosensor\u0026rsquo;s STANDARD\u0026trade; 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\u003cspan\u003e$\u003c/span\u003e 1\u0026ndash;16. The SD Biosensor analyser and test strip costs were US\u003cspan\u003e$\u003c/span\u003e 171\u0026ndash;832 and US\u003cspan\u003e$\u003c/span\u003e 5\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough 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 \u003cem\u003eP. vivax\u003c/em\u003e 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.\u003c/p\u003e","manuscriptTitle":"A review of the cost-effectiveness of using near-patient G6PD tests before treatment with radical cure of vivax malaria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 08:42:49","doi":"10.21203/rs.3.rs-8409096/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-12T21:03:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235830890017740746774413015849509384242","date":"2026-05-01T09:21:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290403250065589587778432294690510327858","date":"2026-04-28T15:31:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8982190975406506369246053214154803235","date":"2026-02-08T11:59:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T07:22:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-20T17:50:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-20T16:49:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-12-20T03:02:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b17229d0-a9cc-4f23-967b-6669cd9e8996","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-12T21:03:42+00:00","index":23,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T07:38:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-23 08:42:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8409096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8409096","identity":"rs-8409096","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}