Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 8;76(3):e810-e819.
doi: 10.1093/cid/ciac427.

Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018

Kyueun Lee  1 , Shiying You  2 , Yunfei Li  3 , Harrell Chesson  4 , Thomas L Gift  4 , Andrés A Berruti  4 , Katherine Hsu  5 , Reza Yaesoubi  2 , Joshua A Salomon  6 , Minttu Rönn  3
Affiliations

Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018

Kyueun Lee et al. Clin Infect Dis. .

Abstract

Background: The purpose of this study was to estimate the health impact of syphilis in the United States in terms of the number of quality-adjusted life years (QALYs) lost attributable to infections in 2018.

Methods: We developed a Markov model that simulates the natural history and management of syphilis. The model was parameterized by sex and sexual orientation (women who have sex with men, men who have sex with women [MSW], and men who have sex with men [MSM]), and by age at primary infection. We developed a separate decision tree model to quantify health losses due to congenital syphilis. We estimated the average lifetime number of QALYs lost per infection, and the total expected lifetime number of QALYs lost due to syphilis acquired in 2018.

Results: We estimated the average number of discounted lifetime QALYs lost per infection as 0.09 (95% uncertainty interval [UI] .03-.19). The total expected number of QALYs lost due to syphilis acquired in 2018 was 13 349 (5071-31 360). Although per-case loss was the lowest among MSM (0.06), MSM accounted for 47.7% of the overall burden. For each case of congenital syphilis, we estimated 1.79 (1.43-2.16) and 0.06 (.01-.14) QALYs lost in the child and the mother, respectively. We projected 2332 (1871-28 250) and 79 (17-177) QALYs lost for children and mothers, respectively, due to congenital syphilis in 2018.

Conclusions: Syphilis causes substantial health losses in adults and children. Quantifying these health losses in terms of QALYs can inform cost-effectiveness analyses and can facilitate comparisons of the burden of syphilis to that of other diseases.

Keywords: burden of disease; quality-adjusted life years; sexually transmitted disease; syphilis.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest . K. H. reports unpaid leadership or fiduciary roles with American STD Association and Massachusetts ID Society. R. Y. reports grants or contracts unrelated to this work from National Institutes of Health and Centers for Disease Control and Prevention and unpaid leadership or fiduciary roles with American STD Association and Massachusetts ID Society. K. L. reports fellowship in Medical Decision Making (2019–2022) from Society for Medical Decision Making/Gordon and Betty Moore Foundation. M. R. reports contract for work on cervical cancer elimination modeling in South Africa, not related to the manuscript, from World Health Organization (2018–2021), trust in Science Exploratory Award, not related to the manuscript, from Harvard Data Science Initiative (2021), and Charles A. King Trust, not related to the manuscript, from Postdoctoral Fellowship Stipend (2018–2020). Y. L. reports postdoctoral fellowship stipend (2020–2022) from Harvard T. H. Chan School of Public Health, not related to the manuscript. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Markov model of syphilis. In our model, tertiary syphilis refers to gummas, cardiovascular syphilis, psychiatric manifestations, and so forth; we included late neurosyphilis as a separate outcome. Black arrows indicate health transitions in the natural history of syphilis. Neurologic symptoms and neurosyphilis can develop at any stage of syphilis (green arrows). Treatment can occur at any stage of syphilis (red arrows show the transition to the “treated” state). Reductions in quality of life attributable to syphilis are incurred at every state in this model, except early latent syphilis and late latent syphilis.
Figure 2.
Figure 2.
Decision tree model used to estimate the number of quality-adjusted life years (QALYs) lost due to congenital syphilis.
Figure 3.
Figure 3.
Lifetime number of QALYs lost due to syphilis (per infection) by age at infection for men who have sex with men (MSM), men who have sex with women (MSW), and women: (A) discounted number of QALYs lost per infection; (B) undiscounted number of QALYs lost per infection. The error bars shown reflect the 2.5th and 97.5 percentiles of results from the sensitivity analyses. Abbreviation: QALY, quality-adjusted life year.
Figure 4.
Figure 4.
Average lifetime number of QALYs lost due to syphilis (per infection) and total number of QALYs lost due to syphilis acquired in 2018 for men who have sex with men (MSM), men who have sex with women (MSW), women, and total population: (A) discounted QALYs lost per infection; (B) undiscounted QALYs per infection; (C) discounted total QALYs lost; (D) undiscounted total QALYs lost. The error bars shown reflect the 2.5th and 97.5 percentiles of results from the sensitivity analyses.
Figure 5.
Figure 5.
Proportion of the number of QALYs lost attributed to each stage of syphilis for men who have sex with men (MSM), men who have sex with women (MSW), and women. Abbreviation: QALY, quality-adjusted life year.
Figure 6.
Figure 6.
Number of QALYs lost due to congenital syphilis: (A) Average number of QALYs lost per case of congenital syphilis; (B) total expected number of QALYs lost due to congenital syphilis cases that occurred in 2018. The error bars shown reflect the 2.5th and 97.5 percentiles of results from the sensitivity analyses. Abbreviation: QALY, quality-adjusted life year.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Sexually Transmitted Disease Surveillance 2019. Atlanta: U.S. Department of Health and Human Services, 2021.
    1. Chesson HW, Peterman TA. The estimated lifetime medical cost of syphilis in the United States. Sexually Transmitted Diseases 2021; 48:253–9. - PMC - PubMed
    1. Neumann PJ, Cohen JT. QALYs in 2018: advantages and concerns. JAMA 2018; 319:2473–4. - PubMed
    1. Ghanem KG, Ram S, Rice PA. The modern epidemic of syphilis. Reply. N Engl J Med 2020; 382:2380. - PubMed
    1. Woods CR. Congenital syphilis-persisting pestilence. Pediatr Infect Dis J 2009; 28:536–7. - PubMed

Publication types