Limits...
Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis.

Kuznik A, Lamorde M, Nyabigambo A, Manabe YC - PLoS Med. (2013)

Bottom Line: However, country-specific cost-effectiveness data for these tests are limited.Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%-14.0%) to 0.038% (range: 0.002%-0.113%).Substantial reduction in DALYs can be achieved at a relatively modest budget impact.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda ; Pfizer, New York, New York, United States of America.

ABSTRACT

Background: Untreated syphilis in pregnancy is associated with adverse clinical outcomes for the infant. Most syphilis infections occur in sub-Saharan Africa (SSA), where coverage of antenatal screening for syphilis is inadequate. Recently introduced point-of-care syphilis tests have high accuracy and demonstrate potential to increase coverage of antenatal screening. However, country-specific cost-effectiveness data for these tests are limited. The objective of this analysis was to evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in SSA and estimate the impact of universal screening on stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs) averted.

Methods and findings: The decision analytic model reflected the perspective of the national health care system and was based on the sensitivity (86%) and specificity (99%) reported for the immunochromatographic strip (ICS) test. Clinical outcomes of infants born to syphilis-infected mothers on the end points of stillbirth, neonatal death, and congenital syphilis were obtained from published sources. Treatment was assumed to consist of three injections of benzathine penicillin. Country-specific inputs included the antenatal prevalence of syphilis, annual number of live births, proportion of women with at least one antenatal care visit, per capita gross national income, and estimated hourly nurse wages. In all 43 sub-Saharan African countries analyzed, syphilis screening is highly cost-effective, with an average cost/DALY averted of US$11 (range: US$2-US$48). Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%-14.0%) to 0.038% (range: 0.002%-0.113%). Universal antenatal screening of pregnant women in clinics may reduce the annual number of stillbirths by up to 64,000, neonatal deaths by up to 25,000, and annual incidence of congenital syphilis by up to 32,000, and avert up to 2.6 million DALYs at an estimated annual direct medical cost of US$20.8 million.

Conclusions: Use of ICS tests for antenatal syphilis screening is highly cost-effective in SSA. Substantial reduction in DALYs can be achieved at a relatively modest budget impact. In SSA, antenatal programs should expand access to syphilis screening using the ICS test. Please see later in the article for the Editors' Summary.

Show MeSH

Related in: MedlinePlus

Decision tree.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3818163&req=5

pmed-1001545-g001: Decision tree.

Mentions: The analysis was based on a decision analytic model (see Figure 1) that evaluated the cost-effectiveness of ICS testing and subsequent treatment with three injections of benzathine penicillin relative to no testing and no treatment in the setting of national antenatal care programs and from the perspective of the national health care system. Direct or indirect patient costs such as costs associated with travel to and from the health care facility were not included. The clinical benefit of treatment in the model was restricted to the infant and applied to a reduction in the probability of stillbirth, early neonatal death, as well as congenital syphilis. A separate decision tree was developed for each of the 43 countries in this analysis.


Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis.

Kuznik A, Lamorde M, Nyabigambo A, Manabe YC - PLoS Med. (2013)

Decision tree.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3818163&req=5

pmed-1001545-g001: Decision tree.
Mentions: The analysis was based on a decision analytic model (see Figure 1) that evaluated the cost-effectiveness of ICS testing and subsequent treatment with three injections of benzathine penicillin relative to no testing and no treatment in the setting of national antenatal care programs and from the perspective of the national health care system. Direct or indirect patient costs such as costs associated with travel to and from the health care facility were not included. The clinical benefit of treatment in the model was restricted to the infant and applied to a reduction in the probability of stillbirth, early neonatal death, as well as congenital syphilis. A separate decision tree was developed for each of the 43 countries in this analysis.

Bottom Line: However, country-specific cost-effectiveness data for these tests are limited.Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%-14.0%) to 0.038% (range: 0.002%-0.113%).Substantial reduction in DALYs can be achieved at a relatively modest budget impact.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda ; Pfizer, New York, New York, United States of America.

ABSTRACT

Background: Untreated syphilis in pregnancy is associated with adverse clinical outcomes for the infant. Most syphilis infections occur in sub-Saharan Africa (SSA), where coverage of antenatal screening for syphilis is inadequate. Recently introduced point-of-care syphilis tests have high accuracy and demonstrate potential to increase coverage of antenatal screening. However, country-specific cost-effectiveness data for these tests are limited. The objective of this analysis was to evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in SSA and estimate the impact of universal screening on stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs) averted.

Methods and findings: The decision analytic model reflected the perspective of the national health care system and was based on the sensitivity (86%) and specificity (99%) reported for the immunochromatographic strip (ICS) test. Clinical outcomes of infants born to syphilis-infected mothers on the end points of stillbirth, neonatal death, and congenital syphilis were obtained from published sources. Treatment was assumed to consist of three injections of benzathine penicillin. Country-specific inputs included the antenatal prevalence of syphilis, annual number of live births, proportion of women with at least one antenatal care visit, per capita gross national income, and estimated hourly nurse wages. In all 43 sub-Saharan African countries analyzed, syphilis screening is highly cost-effective, with an average cost/DALY averted of US$11 (range: US$2-US$48). Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%-14.0%) to 0.038% (range: 0.002%-0.113%). Universal antenatal screening of pregnant women in clinics may reduce the annual number of stillbirths by up to 64,000, neonatal deaths by up to 25,000, and annual incidence of congenital syphilis by up to 32,000, and avert up to 2.6 million DALYs at an estimated annual direct medical cost of US$20.8 million.

Conclusions: Use of ICS tests for antenatal syphilis screening is highly cost-effective in SSA. Substantial reduction in DALYs can be achieved at a relatively modest budget impact. In SSA, antenatal programs should expand access to syphilis screening using the ICS test. Please see later in the article for the Editors' Summary.

Show MeSH
Related in: MedlinePlus