The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.

<h4>Background</h4>Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated...

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Autores principales:	James G Kahn, Aliya Jiwani, Gabriela B Gomez, Sarah J Hawkes, Harrell W Chesson, Nathalie Broutet, Mary L Kamb, Lori M Newman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4cf71ca29d3245c3a9641ef5754e2941
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spelling	oai:doaj.org-article:4cf71ca29d3245c3a9641ef5754e29412021-11-18T08:34:58ZThe cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.1932-620310.1371/journal.pone.0087510https://doaj.org/article/4cf71ca29d3245c3a9641ef5754e29412014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24489931/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million disability-adjusted life years (DALYs) and $309 million in medical costs. Syphilis screening and treatment is simple, effective, and affordable, yet, worldwide, most pregnant women do not receive these services. We assessed cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in various programmatic, epidemiologic, and economic contexts.<h4>Methods and findings</h4>We modeled the cost, health impact, and cost-effectiveness of expanded syphilis screening and treatment in ANC, compared to current services, for 1,000,000 pregnancies per year over four years. We defined eight generic country scenarios by systematically varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare. We calculated program and net costs, DALYs averted, and net costs per DALY averted over four years in each scenario. Program costs are estimated at $4,142,287 - $8,235,796 per million pregnant women (2010 USD). Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program averts an estimated 5,754 - 93,484 DALYs, yielding net savings in four scenarios, and a cost per DALY averted of $24 - $111 in the four scenarios with net costs. Results were robust in sensitivity analyses.<h4>Conclusions</h4>Eliminating MTCT of syphilis through expanded screening and treatment in ANC is likely to be highly cost-effective by WHO-defined thresholds in a wide range of settings. Countries with high prevalence, low current service coverage, and high healthcare cost would benefit most. Future analyses can be tailored to countries using local epidemiologic and programmatic data.James G KahnAliya JiwaniGabriela B GomezSarah J HawkesHarrell W ChessonNathalie BroutetMary L KambLori M NewmanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 1, p e87510 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q James G Kahn Aliya Jiwani Gabriela B Gomez Sarah J Hawkes Harrell W Chesson Nathalie Broutet Mary L Kamb Lori M Newman The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
description	<h4>Background</h4>Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million disability-adjusted life years (DALYs) and $309 million in medical costs. Syphilis screening and treatment is simple, effective, and affordable, yet, worldwide, most pregnant women do not receive these services. We assessed cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in various programmatic, epidemiologic, and economic contexts.<h4>Methods and findings</h4>We modeled the cost, health impact, and cost-effectiveness of expanded syphilis screening and treatment in ANC, compared to current services, for 1,000,000 pregnancies per year over four years. We defined eight generic country scenarios by systematically varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare. We calculated program and net costs, DALYs averted, and net costs per DALY averted over four years in each scenario. Program costs are estimated at $4,142,287 - $8,235,796 per million pregnant women (2010 USD). Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program averts an estimated 5,754 - 93,484 DALYs, yielding net savings in four scenarios, and a cost per DALY averted of $24 - $111 in the four scenarios with net costs. Results were robust in sensitivity analyses.<h4>Conclusions</h4>Eliminating MTCT of syphilis through expanded screening and treatment in ANC is likely to be highly cost-effective by WHO-defined thresholds in a wide range of settings. Countries with high prevalence, low current service coverage, and high healthcare cost would benefit most. Future analyses can be tailored to countries using local epidemiologic and programmatic data.
format	article
author	James G Kahn Aliya Jiwani Gabriela B Gomez Sarah J Hawkes Harrell W Chesson Nathalie Broutet Mary L Kamb Lori M Newman
author_facet	James G Kahn Aliya Jiwani Gabriela B Gomez Sarah J Hawkes Harrell W Chesson Nathalie Broutet Mary L Kamb Lori M Newman
author_sort	James G Kahn
title	The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
title_short	The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
title_full	The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
title_fullStr	The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
title_full_unstemmed	The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
title_sort	cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/4cf71ca29d3245c3a9641ef5754e2941
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The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.

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