Finding a Needle in the Haystack: The costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia

Bruce A. Larson, Deophine Lembela-Bwalya, Rachael Bonawitz, Emily E. Hammond, Donald M. Thea, Julie Herlihy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Methods: Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study.Results: During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60. Conclusions: Screening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.

Original languageEnglish (US)
Article numbere113868
JournalPLoS One
Volume9
Issue number12
DOIs
StatePublished - Dec 5 2014
Externally publishedYes

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Congenital Syphilis
Zambia
cost effectiveness
Syphilis
Cost effectiveness
Needles
Cost-Benefit Analysis
disability-adjusted life year
pregnancy
Costs and Cost Analysis
Pregnancy
Quality-Adjusted Life Years
Costs
testing
Health Care Costs
prenatal care
screening
Therapeutics
health care workers
Guideline Adherence

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Finding a Needle in the Haystack : The costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia. / Larson, Bruce A.; Lembela-Bwalya, Deophine; Bonawitz, Rachael; Hammond, Emily E.; Thea, Donald M.; Herlihy, Julie.

In: PLoS One, Vol. 9, No. 12, e113868, 05.12.2014.

Research output: Contribution to journalArticle

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abstract = "Background: In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Methods: Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study.Results: During the evaluation study, 62{\%} of patients received a RST, and 2.8{\%} of patients tested were positive (and 10.4{\%} of these were treated). Even with very high RST sensitivity and specificity (98{\%}), true prevalence of active syphilis would be substantially less (estimated at <0.7{\%}). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60. Conclusions: Screening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.",
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