J Korean Med Sci.  2022 Jul;37(27):e212. 10.3346/jkms.2022.37.e212.

Cost-Benefit Analysis of Tafenoquine for Radical Cure of Plasmodium vivax Malaria in Korea

• Suh J
• Kim JH
• Kim JD
• Kim C
• Choi JY
• Lee J
• Yeom JS

• KMID: 2531250
• DOI: http://doi.org/10.3346/jkms.2022.37.e212

Abstract

Background
Plasmodium vivax malaria has a persistent liver stage that causes relapse, and introducing tafenoquine to suppress relapse could aid in disease eradication. Therefore, we assessed the impact of tafenoquine introduction on P. vivax malaria incidence and performed a cost-benefit analysis from the payer’s perspective.
Methods
We expanded the previously developed P. vivax malaria dynamic transmission model and calibrated it to weekly civilian malaria incidences in 2014–2018. Primaquine and tafenoquine scenarios were considered by assuming different relapse probabilities, and relapse and total P. vivax malaria cases were predicted over the next decade for each scenario. We then estimated the number of cases prevented by replacing primaquine with tafenoquine. The cost and benefit of introducing tafenoquine were obtained using medical expenditure from a nationwide database, and a cost-benefit analysis was conducted. A probabilistic sensitivity analysis was performed to assess the economic feasibility robustness of tafenoquine introduction under uncertainties of model parameters, costs, and benefits.
Results
Under 0.04 primaquine relapse probability, the introduction of tafenoquine with relapse probability of 0.01 prevented 129 (12.27%) and 35 (77.78%) total and relapse cases, respectively, over the next decade. However, under the same relapse probability as primaquine, introducing tafenoquine had no additional preventative effect. The 14-day primaquine treatment cost was $3.71. The tafenoquine and the glucose-6-phosphate dehydrogenase rapid diagnostic testing cost $57.37 and $7.76, totaling $65.13. The average medical expenditure per malaria patient was estimated at $1444.79. The cost-benefit analysis results provided an incremental benefit-cost ratio (IBCR) from 0 to 3.21 as the tafenoquine relapse probability decreased from 0.04 to 0.01. The probabilistic sensitivity analysis showed an IBCR > 1, indicating that tafenoquine is beneficial, with a probability of 69.1%.
Conclusion
Tafenoquine could reduce P. vivax malaria incidence and medical costs and bring greater benefits than primaquine.

Keyword

Plasmodium vivax; Malaria; Modeling; Tafenoquine; Cost-Benefit Analysis

Figure

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  Fig. 1 Annual relapse incidences based on relapse control scenario.PQ = primaquine, TQ = tafenoquine, q = relapse probability.

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  Fig. 2 Tornado box plots of univariate sensitivity. (A) Relative sensitivity of IBCR for each TQ scenario and (B) Sensitivity of IBCR under feasible parameters ranges for each TQ scenario.G6PD = glucose-6-phosphate dehydrogenase, IBCR = incremental benefit-cost ratio, PQ = primaquine, RDT = rapid diagnostic tests, TQ = tafenoquine.

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  Fig. 3 Bivariate and multivariate sensitivity. (A) IBCR contour of bivariate sensitivity based on the relapse probabilities of PQ and TQ and (B) Cost-benefit plane of multivariate sensitivity.IBCR = incremental benefit-cost ratio, PQ = primaquine, TQ = tafenoquine.

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