Publication: Implementation of field detection devices for antimalarial quality screening in lao pdr—a cost-effectiveness analysis
Issued Date
2021-09-01
Resource Type
ISSN
19352735
19352727
19352727
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2-s2.0-85116442885
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Mahidol University
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SCOPUS
Bibliographic Citation
PLoS Neglected Tropical Diseases. Vol.15, No.9 (2021)
Suggested Citation
Nantasit Luangasanatip, Panarasri Khonputsa, Céline Caillet, Serena Vickers, Stephen Zambrzycki, Facundo M. Fernández, Paul N. Newton, Yoel Lubell Implementation of field detection devices for antimalarial quality screening in lao pdr—a cost-effectiveness analysis. PLoS Neglected Tropical Diseases. Vol.15, No.9 (2021). doi:10.1371/journal.pntd.0009539 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77867
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Title
Implementation of field detection devices for antimalarial quality screening in lao pdr—a cost-effectiveness analysis
Abstract
Substandard and falsified (SF) antimalarials have devastating consequences including increased morbidity, mortality and economic losses. Portable medicine quality screening devices are increasingly available, but whether their use for the detection of SF antimalarials is cost-effective is not known. We evaluated the cost-effectiveness of introducing such devices in post-market surveillance in pharmacies in Laos, conservatively focusing on their outcome in detecting SF artemisinin-based combination therapies (ACTs). We simulated the deployment of six portable screening devices: two handheld near-infrared [MicroPHA-ZIR RX, NIR-S-G1], two handheld Raman [Progeny, TruScan RM]; one portable mid-infra-red [4500a FTIR] spectrometers, and single-use disposable paper analytical devices [PADs]. We considered two scenarios with high and low levels of SF ACTs. Different sampling strategies in which medicine inspectors would test 1, 2, or 3 sample(s) of each brand of ACT were evaluated. Costs of inspection including device procurement, inspector time, reagents, reference testing, and replacement with genuine ACTs were estimated. Outcomes were measured as disability adjusted life years (DALYs) and incremental cost-effec-tiveness ratios were estimated for each device compared with a baseline of visual inspections alone. In the scenario with high levels of SF ACTs, all devices were cost-effective with a 1-sample strategy. In the scenario of low levels of SF ACTs, only four devices (MicroPHAZIR RX, 4500a FTIR, NIR-S-G1, and PADs) were cost-effective with a 1-sample strategy. In the multi-way comparative analysis, in both scenarios the NIR-S-G1 testing 2 samples was the most cost-effective option. Routine inspection of ACT quality using portable screening devices is likely to be cost-effective in the Laos context. This work should encourage policy-makers or regulators to further investigate investment in portable screening devices to detect SF medicines and reduce their associated undesired health and economic burdens.