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The cost-effectiveness of single-dose azithromycin for treatment
of incubating syphilis.
Sexually Transmitted Diseases 2003;30(6):502-508.
Blandford JM, Gift TL.
Abstract
BACKGROUND: Treatment of incubating syphilis with intramuscular benzathine
penicillin in exposed sex partners is not always practical in the field,
and exposed partners may not adhere to referrals for treatment at clinical
facilities. The availability of a single-dose oral therapy could increase
the number of partners treated and reduce future infections. GOAL: The goal
of the study was to evaluate the cost-effectiveness of directly observed
oral administration of azithromycin as an alternative to referral for treatment
with benzathine penicillin. STUDY DESIGN: Using published probability and
cost estimates, we constructed a decision-analysis model to compare the direct
costs and effectiveness of field treatment with azithromycin (1-g single
dose) versus referral for standard benzathine penicillin therapy. RESULTS:
At public-sector pricing ($11.50 U.S. dollars), directly observed field treatment
with azithromycin is cost-saving from both the program and healthcare system
perspectives at efficacy levels as low as 75%. Azithromycin therapy is cost-saving
at the wholesale price of $17.32 U.S. dollars (sachet formulation) when efficacy
is at least 90%. The more expensive tablet formulation (average wholesale
price of $27.89 U.S. dollars) is not cost-saving from a program perspective,
but it remains cost-saving from a healthcare system perspective if efficacy
rates are at least 90%. Azithromycin therapy (1-g single dose) will result
in fewer cases of early syphilis among exposed partners, provided that the
drug's efficacy is at least 87%. CONCLUSIONS: Azithromycin is a cost-effective
alternative treatment for incubating syphilis in settings where standard
intramuscular therapy is not practical.