Cost-Effectiveness Analysis of Point-of-Care Rapid Testing Versus Laboratory-Based Testing for Antenatal Screening of Syphilis in Brazil
Cost-Effectiveness Analysis of Point-of-Care Rapid Testing Versus Laboratory-Based Testing for Antenatal Screening of Syphilis in Brazil
Data
2020
Autores
Romero, Carmen Phang
Marinho, Daniel S.
Castro, Rodolfo
Pereira, Claudia Cristina de Aguiar
Silva, Everton
Caetano, Rosângela
Elias, Flavia Tavares Silva
Chilcott, James
Dixon, Simon
Journal Title
Journal ISSN
Volume Title
Publisher
VALUE IN HEALTH REGIONAL ISSUES
Resumo
Objectives: Severe consequences of mother-to-child transmission of syphilis and high increasing incidence of congenital
syphilis remains an important public health problem in Brazil. Our objective was to assess the cost-effectiveness of a
rapid point-of-care test (RT) and treatment of positive mothers immediately compared with a laboratory-based standard
test (ST) with treatment at next follow-up visit.
Methods: A decision analytic model was developed to estimate the incremental cost-effectiveness ratio (ICER) between
antenatal syphilis screening strategies. The model was built with lifetime horizon from Brazilian health system
perspective using 3% and 5% discount rates. A hypothetical cohort of pregnant women at reproductive age were used in
the model. Health outcomes: low birth weight, stillbirths, neonatal deaths and congenital syphilis were estimated in
disability-adjusted life-years (DALYs) lost. Microcosting study and secondary data provided parameters of direct medical
costs. Probabilistic sensitivity analysis was undertaken.
Results: For base case, the mean cost per pregnant woman screened was $2.63 (RT) and $2.48 (ST), respectively. Maternal
syphilis was associated with a loss of 0.0043 DALYs (RT) and 0.0048 DALYs (ST) per mother screened. Expected value of
incremental cost per DALY averted was $298.08. After 10 000 probabilistic sensitivity analysis model runs, incremental cost
and health benefits were $0.15 (95% credible interval –1.56 to 1.92) and 0.00042 DALYs (95% credible interval –0.0036 to
0.0044), respectively, with a mean ICER of $357.44 per DALY. Screening with RT has a 58% chance of being the optimal strategy
at a threshold of $3,200 per DALY.
Conclusions: In Brazil, antenatal screening with syphilis RT and immediate treatment is likely to be cost-effective compared
with standard screening and must be prioritized in local settings.
Description
Palavras-chave
cost-effectiveness, maternal syphilis, pregnant women, rapid test, syphilis screening.
Citação
Romero CP, Marinho DS, Castro R, de Aguiar Pereira CC, Silva E, Caetano R, Silva Elias FT, Chilcott J, Dixon S. Cost-Effectiveness Analysis of Point-of-Care Rapid Testing Versus Laboratory-Based Testing for Antenatal Screening of Syphilis in Brazil. Value Health Reg Issues. 2020 Dec;23:61-69. doi: 10.1016/j.vhri.2020.03.004. Epub 2020 Aug 22.