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Cost-effectiveness of on-site antenatal screening to prevent congenital syphilis in rural Eastern Cape Province, Republic of South Africa.
Sexually Transmitted Diseases:Volume 34(7) SupplementJuly 2007pp S61-S66
Blandford JM, Gift TL, Vasaikar S, Mwesigwa-Kayongo D, Dlali
P, Bronzan RN.
Abstract
OBJECTIVES: On-site screening and same-day treatment of maternal syphilis
in underresourced settings can avert greater numbers of congenital syphilis
cases, but health outcomes and associated costs must be evaluated jointly.
METHODS: We used decision analysis to estimate the incremental cost-effectiveness
of two on-site antenatal syphilis screening strategies to avert congenital
infections-qualitative RPR (on-site RPR) and treponemal immunochromatographic
strip assay (on-site ICS)-compared to the current practice (off-site RPR/TPHA).
FINDINGS: With antenatal active syphilis prevalence of 6.3%, the incremental
cost-effectiveness of on-site ICS in averting congenital infections was estimated
to be USD104, averting 82% of cases expected in absence of a program. The
incremental cost-effectiveness of off-site RPR/TPHA was USD82 but would avert
only 55% of congenital syphilis cases. On-site RPR was dominated by the other
screening strategies. CONCLUSIONS: In settings of high maternal syphilis prevalence,
on-site antenatal screening with ICS is a cost-effective approach to reduce
the incidence of congenital syphilis.