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. 2015 Jun;130 Suppl 1(Suppl 1):S73-80.
doi: 10.1016/j.ijgo.2015.04.007. Epub 2015 Apr 29.

The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia

Fern Terris-Prestholt  1 , Peter Vickerman  2 , Sergio Torres-Rueda  3 , Nancy Santesso  4 , Sedona Sweeney  3 , Patricia Mallma  5 , Katharine D Shelley  6 , Patricia J Garcia  6 , Rachel Bronzan  7 , Michelle M Gill  8 , Nathalie Broutet  9 , Teodora Wi  9 , Charlotte Watts  3 , David Mabey  3 , Rosanna W Peeling  3 , Lori Newman  9
Affiliations

The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia

Fern Terris-Prestholt et al. Int J Gynaecol Obstet. 2015 Jun.

Abstract

Objective: Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women.

Methods: Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results.

Results: Although this analysis found screening using RPR to be relatively cheap, most (>70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women.

Conclusion: This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings.

Keywords: Africa; Cost-effectiveness analysis; Diagnostic algorithms; Latin America; Syphilis screening and treatment.

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Figures

Fig. 1
Fig. 1
Screening and treatment approaches. +, Only non-treponemal antibody test results used; ++, Dual RST – both treponemal and non-treponemal antibody test results used to determine a positive case; Trep, Treponemal antibody test result; non-Trep, Non-treponemal antibody test result; RPR, Rapid plasma reagin; RST, Rapid syphilis test.
Fig. 2
Fig. 2
Comparison of approach by key indicators: health impact (total true cases averted), budget impact (total cost), and cost-effectiveness (cost per DALY averted), by country and screening and treatment approach. Costs are presented in 2012 US dollars. 0. None (No screening); A. Clinic RPR; B. Single RST; C. Dual treat ++; D. Dual treat +; E. Single RST → RPR; F. Clinic RPR → Single RST; G. Single RST → Dual treat ++; H. Single RST → Dual treat +; I. Mass treatment.
Fig. 3
Fig. 3
The relationship between cost-effectiveness (US $/DALY averted) and true syphilis prevalence. Costs are presented in 2012 US dollars.
See this image and copyright information in PMC

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