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

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....

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Autores principales:	Nantasit Luangasanatip, Panarasri Khonputsa, Céline Caillet, Serena Vickers, Stephen Zambrzycki, Facundo M Fernández, Paul N Newton, Yoel Lubell
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/bd004655ee7240b8aa38c5c8097fa550
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spelling	oai:doaj.org-article:bd004655ee7240b8aa38c5c8097fa5502021-12-02T20:24:00ZImplementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.1935-27271935-273510.1371/journal.pntd.0009539https://doaj.org/article/bd004655ee7240b8aa38c5c8097fa5502021-09-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009539https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735Substandard 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 [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) and incremental cost-effectiveness 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.Nantasit LuangasanatipPanarasri KhonputsaCéline CailletSerena VickersStephen ZambrzyckiFacundo M FernándezPaul N NewtonYoel LubellPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 9, p e0009539 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 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.
description	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 [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) and incremental cost-effectiveness 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.
format	article
author	Nantasit Luangasanatip Panarasri Khonputsa Céline Caillet Serena Vickers Stephen Zambrzycki Facundo M Fernández Paul N Newton Yoel Lubell
author_facet	Nantasit Luangasanatip Panarasri Khonputsa Céline Caillet Serena Vickers Stephen Zambrzycki Facundo M Fernández Paul N Newton Yoel Lubell
author_sort	Nantasit Luangasanatip
title	Implementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.
title_short	Implementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.
title_full	Implementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.
title_fullStr	Implementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.
title_full_unstemmed	Implementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.
title_sort	implementation of field detection devices for antimalarial quality screening in lao pdr-a cost-effectiveness analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/bd004655ee7240b8aa38c5c8097fa550
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Implementation of field detection devices for antimalarial quality screening in Lao PDR-A cost-effectiveness analysis.

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