Aims: To elucidate the costs associated with vivax malaria across a range of endemic settings.
Methods: Cost data were collected in the context of a multi-centred clinical trial comparing 7 and 14-day primaquine regimens in Afghanistan, Ethiopia, Indonesia and Vietnam. Patients were surveyed on days 0 and 14 to determine the costs of treatment and transportation, and the duration that they and any caregiver were unable to perform usual activities. These productivity losses were valued at one gross domestic product per capita per day. Micro-costing was used to collect the additional costs required to diagnose and treat vivax malaria.
Results: The mean (SD) total households costs ranged from US$8.4 (US$4.2) in Afghanistan to US$68.6 (US$ 66.8) in Indonesia. Across all countries, the productivity costs were the largest cost component with a median (range) of 2.5 (1-4) days for patients and 1 (0.5 - 3) day for carers. The cost of administering a G6PD RDT ranged from US$0.9 to US$13.9 and this was consistently lower than the costs of the widely-used Fluorescent Spot Test (FST), which ranged from US$13.7 to US$17.9. The cost of a HaemocueTM test to monitor for anaemia ranged from US$0.2 in Ethiopia to US$1.6 in Indonesia.
Conclusions: Screening for G6PD deficiency with an RDT was less costly than testing with FST. An episode of vivax malaria results in substantial costs to households. These costs are primarily due to productivity losses, which are often excluded from economic evaluations. A better understanding of these costs is needed to optimise the allocation of resources for malaria elimination.