Implementation of field detection devices for antimalarial quality screening in Lao PDR —A cost-effectiveness analysis

by Nantasit Luangasanatip, Panarasri Khonputsa, C éline Caillet, Serena Vickers, Stephen Zambrzycki, Facundo M. Fernández, Paul N. Newton, Yoel Lubell 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 know n. 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 n ear-infrared [MicroPHAZIR RX, NIR-S-G1], two handheld Raman [Progeny, TruScan RM]; one portable mid-infrared [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) a nd incremental cost-effectiveness ratios were estimated for each device compared with a baseline of visual inspections alone. In the scenario wit...
Source: PLoS Neglected Tropical Diseases - Category: Tropical Medicine Authors: Source Type: research