The cost‐effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia
Open accessAbstract
Objective: Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non‐treponemal antibodies (dual RSTs) are now available. This study assessed the cost‐effectiveness of algorithms using these tests to screen pregnant women. Methods: Observed costs of maternal syphilis screening and treatment using clinic‐based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost‐effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results. Results: Although this analysis found screening using RPR to be relatively cheap, most (> 70%) true cases went untreated. Algorithms using single RSTs were the most cost‐effective in all observed settings, followed by dual RSTs, which became the most cost‐effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women. Conclusion: This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings.
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Two studies reported that dual treponemal/non-treponemal RDTs were more cost-effective and potentially cost saving if used in settings providing antenatal care.
“Two studies reporting on cost–effectiveness were identified by the evidence review and reported that RDTs were more cost-effective and potentially cost saving if used in settings providing antenatal care (55, 56).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [56]
The Results (Cost-effectiveness; page unavailable) support cost-effectiveness of rapid tests in antenatal care, but say single treponemal RSTs were the most cost-effective in all three countries; dual tests were less cost-effective at their current price. The reported cost saving in Peru was for switching to a single RST, not a dual test. Dual RSTs became the most cost-effective only if their price was halved (Abstract, Results). (LLM, conf=0.90)
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- Authors
- Terris‐Prestholt, F., Vickerman, P., Torres‐Rueda, S., Santesso, N., Sweeney, S., Mallma, P., Shelley, K. D., Garcia, P. J., Bronzan, R., Gill, M. M., Broutet, N., Wi, T., Watts, C., Mabey, D., Peeling, R. W., & Newman, L.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University of Bristol (GB)
- McMaster University (CA)
- Universidad Peruana Cayetano Heredia (PE)
- Johns Hopkins University (US)
- Health & Development International (US)
- Elizabeth Glaser Pediatric AIDS Foundation (US)
- World Health Organization (CH)
- Corresponding author
- Terris‐Prestholt, Fern
- ORCID
- Venue
- International Journal of Gynecology & Obstetrics
- Publisher
- Wiley
- Published
- 2015-04-29
- Volume
- 130
- Issue
- S1
- Pages
- S73-80
- ISSN
- 0020-6695 (ISSN-L)
- 0020-7292
- 1879-3479
- PMC
- PMC4510253
- OpenAlex
- W1965812760
- Cited by
- 32
- References
- 35
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 2 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 4 · 2017: 7 · 2016: 3 · 2015: 1
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Gynecology & Obstetrics (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by-nc-nd)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Explore Bristol Research (submittedVersion, cc-by-nc-nd)
- Funders
- Bill and Melinda Gates Foundation (47697)
- Department of Reproductive Health and Research, WHO
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- antenatal syphilis screening, maternal syphilis, cost-effectiveness, RPR, immunochromatographic strip test, Treponema pallidum antibodies, screening algorithm, mass treatment, pregnant women, Peru, Tanzania, Zambia
- MeSH terms
- Algorithms, Cost-Benefit Analysis, Female, Humans, Mass Screening, Peru, Pregnancy, Pregnancy Complications, Infectious, Prenatal Diagnosis, Sensitivity and Specificity, Syphilis, Syphilis Serodiagnosis, Tanzania, Zambia
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