Cargando…
The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model
BACKGROUND: 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 dis...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906198/ https://www.ncbi.nlm.nih.gov/pubmed/24489931 http://dx.doi.org/10.1371/journal.pone.0087510 |
_version_ | 1782301459487916032 |
---|---|
author | Kahn, James G. Jiwani, Aliya Gomez, Gabriela B. Hawkes, Sarah J. Chesson, Harrell W. Broutet, Nathalie Kamb, Mary L. Newman, Lori M. |
author_facet | Kahn, James G. Jiwani, Aliya Gomez, Gabriela B. Hawkes, Sarah J. Chesson, Harrell W. Broutet, Nathalie Kamb, Mary L. Newman, Lori M. |
author_sort | Kahn, James G. |
collection | PubMed |
description | BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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 | Online Article Text |
id | pubmed-3906198 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-39061982014-01-31 The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model Kahn, James G. Jiwani, Aliya Gomez, Gabriela B. Hawkes, Sarah J. Chesson, Harrell W. Broutet, Nathalie Kamb, Mary L. Newman, Lori M. PLoS One Research Article BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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. Public Library of Science 2014-01-29 /pmc/articles/PMC3906198/ /pubmed/24489931 http://dx.doi.org/10.1371/journal.pone.0087510 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. |
spellingShingle | Research Article Kahn, James G. Jiwani, Aliya Gomez, Gabriela B. Hawkes, Sarah J. Chesson, Harrell W. Broutet, Nathalie Kamb, Mary L. Newman, Lori M. The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model |
title | 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_short | 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 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906198/ https://www.ncbi.nlm.nih.gov/pubmed/24489931 http://dx.doi.org/10.1371/journal.pone.0087510 |
work_keys_str_mv | AT kahnjamesg thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT jiwanialiya thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT gomezgabrielab thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT hawkessarahj thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT chessonharrellw thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT broutetnathalie thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT kambmaryl thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT newmanlorim thecostandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT kahnjamesg costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT jiwanialiya costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT gomezgabrielab costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT hawkessarahj costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT chessonharrellw costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT broutetnathalie costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT kambmaryl costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel AT newmanlorim costandcosteffectivenessofscalingupscreeningandtreatmentofsyphilisinpregnancyamodel |