Modelling the cost-effectiveness of introducing rapid syphilis tests into an antenatal syphilis screening programme in Mwanza, Tanzania.
Abstract
Objectives: A study found screening (with rapid plasma reagin (RPR)) pregnant women for maternal syphilis was cost-effective in Mwanza, Tanzania. Recently, four rapid point-of-care (POC) syphilis tests were evaluated in Mwanza, and found to have reasonable sensitivity/specificity. This analysis estimates the relative cost-effectiveness of using these POC tests in the Mwanza syphilis screening intervention. Methods: Empirical cost and epidemiological data were used to model the potential benefit of using POC tests instead of RPR. Reductions in costs relating to training, supplies, and equipment were estimated, and any changes in impact due to test sensitivity were included. Additional modelling explored how the results vary with prevalence of past infection, misclassified RPR results, and if not all women return for treatment. Results: The cost-effectiveness of using POC tests is mainly dependent on their cost and sensitivity for high titre active syphilis (HTAS). Savings due to reductions in training and equipment are small. Current POC tests may save more disability-adjusted life years (DALYs) than the RPR test in Mwanza, but the test cost needs to be <us to="" be="" as="" cost-effective="" rpr.="" however="" the="" cost-effectiveness="" of="" rpr="" test="" worsens="" by="" if="" its="" htas="" sensitivity="" had="" been="" instead="" and="" women="" not="" returned="" for="" treatment.="" in="" such="" settings="" poc="" tests="" could="" improve="" cost-effectiveness.="" lastly="" is="" affected="" little="" prevalence="" syphilis="" false="" rpr-positives="" past="" infections.="" although="" price="" most="" needs="" reduced="" make="" them="" their="" simplicity="" limited="" requirements="" electricity="" suggest="" use="" coverage="" antenatal="" screening="" developing="" countries="" discussion:="" />
Citation
Sexually Transmitted Infections (2006) 82 (Suppl. 5) v38-v43.[doi:10.1136/sti.2006.021824]