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Rapid diagnostic tests (RDTs) have been widely used for diagnosing Plasmodium vivax malaria, especially in resource-limited countries. However, the impact of RDTs on the overall P. vivax malaria incidence and national medical costs has not been evaluated. We assessed the effects of RDT initiation on P. vivax malaria incidence and overall medical expenditures in South Korea, a country with a qualified medical environment, and performed a cost-benefit analysis from the payer's perspective. 방법 We developed a dynamic compartmental model for P. vivax malaria transmission in South Korea using delay differential equations. The model was calibrated to the civilian malaria incidences in 2014-2018 reported by Korea Centers for Disease Control and Prevention. We then estimated averted malaria cases and total medical costs from two diagnostic scenarios, namely, microscopy only and both microscopy and RDT. Medical costs, including the prices of RDT and microscopy, were extracted based on data of a hospital where located in areas at risk for P. vivax malaria and validated by data from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of South Korea. We conducted a cost-benefit analysis of RDT using the incremental benefit cost ratio (IBCR) considering only medical costs and performed a sensitivity analysis to reflect the uncertainties of model parameters, costs, and benefits. 결과 The results showed that 55.3% of new malaria cases were averted and saved $696,214 in medical costs in 10 years after RDT introduction due to the reduced risk of secondary infections from diagnosis delay. The estimated IBCR was 2.5, indicating that RDT implementation was beneficial compared to microscopy alone. The IBCR was sensitive to a short latency period, infectious period, and diagnosis time reduction and provided beneficial results in a benefit over $10.6 or RDT cost under $39.7. 결론 The introduction of RDT significantly reduced malaria incidence and reduced medical costs. Moreover, the cost-benefit analysis demonstrated that RDTs introduction were beneficial over microscopy alone. These results support the need for the widespread adoption of RDTs and national health insurance coverage for RDT. [ABSTRACT FROM AUTHOR]

Plasmodium vivax malaria has been one of the most troublesome diseases in North Korea. As most of the malaria cases occurred near the demilitarized zone, radical elimination efforts between South and North Korea are required to achieve a malaria-free Korea Peninsula. This study assessed the impact of rapid diagnostic tests (RDTs) and tafenoquine on malaria incidence in North Korea. 방법 We developed a mathematical model for Plasmodium vivax malaria transmission and calibrated the model to annual malaria cases in 2014-2018 in North Korea reported by the World Health Organization. We also used demographic and climate data in malaria-risk areas to predict realistic malaria incidence in North Korea. The model estimated averted malaria cases over 10 years after the introduction of RDTs and tafenoquine compared to microscopy alone and primaquine, respectively. Sensitivity analysis was performed to reflect the uncertainties of model parameters. 결과 After ten years of continuous integrated RDT, the incidence of malaria in North Korea is decreasing. Compared to microscopic diagnostic time, RDT shortened diagnostic time, resulting in reduced incidence rate by shortening the infectious period (microscopic diagnostic time 5 days: 3182 cases, RDT diagnostic time 4.5 days: 1013 cases, RDT diagnostic time 4 days: 280 cases, RDT diagnostic time 3.5 days: 65 cases, RDT diagnostic time 3 days:12 cases occur, respectively). Model simulations for an administration of tafenoquine were run from 2019 to 2028. In consequence of tafenoquine introduction, the overall malaria occurrence was reduced by decreasing relapse rate (primaquine relapse rate 4%: 3182 cases, tafenoquine relapse rate 1%: 2249 cases, tafenoquine relapse rate 0.7%: 2169 cases, tafenoquine relapse rate 0.4%: 2092 cases, tafenoquine relapse rate 0.01%, 2008 cases occur). When both interventions were initiated simultaneously, the effect on reducing overall malaria occurrence is dramatic. 결론 Simultaneous and continuous implementation of RDT and tafenoquine is an effective way to combat malaria in North Korea ultimately. [ABSTRACT FROM AUTHOR]