Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries A Cost-Effectiveness Analysis.docVIP

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Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries A Cost-Effectiveness Analysis.doc

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Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries A Cost-Effectiveness Analysis

AntenatalSyphilisScreeningUsingPoint-of-CareTesting inSub-SaharanAfricanCountries:ACost-Effectiveness Analysis AndreasKuznik1,2,MohammedLamorde1*,AgnesNyabigambo1,YukariC.Manabe1,3 1InfectiousDiseasesInstitute,MakerereCollegeofHealthSciences,Kampala,Uganda,2Pfizer,NewYork,NewYork,UnitedStatesofAmerica,3DivisionofInfectious Diseases,DepartmentofMedicine,JohnsHopkinsSchoolofMedicine,Baltimore,Maryland,UnitedStatesofAmerica 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-specificcost-effectivenessdataforthesetestsarelimited.Theobjectiveofthisanalysiswasto evaluatethecost-effectivenessandbudgetimpactofantenatalsyphilisscreeningfor43countriesinSSAandestimatethe impactofuniversalscreeningonstillbirths,neonataldeaths,congenitalsyphilis,anddisability-adjustedlifeyears(DALYs) averted. MethodsandFindings:Thedecisionanalyticmodelreflectedtheperspectiveofthenationalhealthcaresystemandwas based on the sensitivity (86%) and specificity (99%) reported for the immunochromatographic strip (ICS) test. Clinical outcomesofinfantsborntosyphilis-infectedmothersontheendpointsofstillbirth,neonataldeath,andcongenitalsyphilis were obtained from published sources. Treatment was assumed to consist of three injections of benzathine penicillin. Country-specificinputsincludedtheantenatalprevalenceofsyphilis,annualnumberoflivebirths,proportionofwomen withatleastoneantenatalcarevisit,percapitagrossnationalincome,andestimatedhourlynursewages.Inall43sub- SaharanAfricancountriesanalyzed,syphilisscreeningishighlycost-effective,withanaveragecost/DALYavertedofUS$11 (range:US$2–US$48).Screeningremainshighlycost-effectiveeveniftheaverageprevalencefallsfromthecurren