title: G6PD deficiency in male individuals infected by Plasmodium vivax malaria in the Brazilian Amazon: a cost study.
abstract: BACKGROUND
  Deficiency of the enzyme G6PD (G6PDd) is caused by mutations in the gene G6PD, which plays an important role in protecting the red blood cell against oxidizing agents; it is linked to chromosome X, and it may affects both sexes. The clinically relevant manifestations, such as acute haemolytic anaemia, mainly occur in men, however. The 8-aminoquinoline primaquine, which is the medication used in the radical treatment of malaria caused by Plasmodium vivax, represents the main factor that triggers complications associated with G6PDd. The current study aims to estimate the costs of G6PDd among male individuals infected by P. vivax in the Brazilian Amazon.
  
  
  METHODS
  This is an economic analysis developed within the Brazilian National Health System perspective for the years of 2009, 2010 and 2011. Direct medical and non-medical costs were estimated for G6PDd in the Brazilian Amazon, considering among those suffering from the deficiency the costs of diagnosing infection by P. vivax, its treatment and severe adverse events that require hospitalization and were connected to the use of primaquine.
  
  
  RESULTS
  The estimates of the average costs of diagnosing vivax malaria, of its treatment and of severe adverse events after using primaquine among the carriers of G6PDd, over the three evaluated years, corresponded to US$ 739,410.42; US$ 2,120.04 and US$ 4,858,108.87, respectively. The results indicate that the average total cost in the study period corresponded to US$ 5,599,639.33, varying in accordance with the sensitivity analysis between US$ 4,439,512.14 and US$ 6,702,619.24.
  
  
  CONCLUSIONS
  The results indicate that the use of primaquine among men with G6PDd who are infected by P. vivax represents a heavy burden on the public health service of Brazil.
authors.affiliation: Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil. henrymaiap9@gmail.com.|University Centre of Brasília, Brasília, Federal District, Brazil. henrymaiap9@gmail.com.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Peixoto
authors.affiliation: Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. marceloambrito@gmail.com.|University of the State of Amazonas, Manaus, Amazonas, Brazil. marceloambrito@gmail.com.
authors.forename: Marcelo A M
authors.initials: MA
authors.lastname: Brito
authors.affiliation: Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil. gromero@unb.br.|National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, RS, Brazil. gromero@unb.br.
authors.forename: Gustavo A S
authors.initials: GA
authors.lastname: Romero
authors.affiliation: Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. wueltonmm@ibest.com.br.|University of the State of Amazonas, Manaus, Amazonas, Brazil. wueltonmm@ibest.com.br.
authors.forename: Wuelton M
authors.initials: WM
authors.lastname: Monteiro
authors.affiliation: Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. marcuslacerda.br@gmail.com.|University of the State of Amazonas, Manaus, Amazonas, Brazil. marcuslacerda.br@gmail.com.|Centro de Pesquisas Leônidas & Maria Deane, FIOCRUZ, Manaus, Amazonas, Brazil. marcuslacerda.br@gmail.com.
authors.forename: Marcus V G
authors.initials: MV
authors.lastname: de Lacerda
authors.affiliation: Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil. reginafernan@gmail.com.|National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, RS, Brazil. reginafernan@gmail.com.
authors.forename: Maria Regina F
authors.initials: MR
authors.lastname: de Oliveira
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016780:Malaria, Vivax / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000469:parasitology; D008297:Male; D010966:Plasmodium vivax / Q000502:physiology*; D011319:Primaquine / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D011319:Primaquine