A decision-tree model built on individual-level data from patients given 7 mg/kg primaquine dosed by G6PD activity compared a revised case-management package - G6PD screening, targeted high-dose primaquine and early clinical review - with business-as-usual over six months in Indonesia. The package averted 0.0011 DALYs per patient at an incremental health system cost of US$7.40, an ICER of US$6,636 per DALY averted, above the US$4,925 (1x GDP per capita) threshold. Results varied by setting, from US$5,098 per DALY averted in Papua to US$80,825 in northern Sumatra, and fell to US$2,261 nationally when societal costs were included.
Why it is interesting: Shows how far a single national ICER can conceal variation by transmission setting and by analytic perspective, with recurrence risk the dominant parameter.