Cost-Effectiveness Analysis of Point-of-Care Rapid Testing Versus Laboratory-Based Testing for Antenatal Screening of Syphilis in Brazil

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dc.contributor.authorRomero, Carmen Phang
dc.contributor.authorMarinho, Daniel S.
dc.contributor.authorCastro, Rodolfo
dc.contributor.authorPereira, Claudia Cristina de Aguiar
dc.contributor.authorSilva, Everton
dc.contributor.authorCaetano, Rosângela
dc.contributor.authorElias, Flavia Tavares Silva
dc.contributor.authorChilcott, James
dc.contributor.authorDixon, Simon
dc.date.accessioned2024-12-05T17:52:43Z
dc.date.available2024-12-05T17:52:43Z
dc.date.issued2020
dc.description.abstractObjectives: 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.
dc.identifier.citationRomero 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.
dc.identifier.otherDOI: 10.1016/j.vhri.2020.03.004
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/666
dc.language.isoen
dc.publisherVALUE IN HEALTH REGIONAL ISSUES
dc.subjectcost-effectivenessen
dc.subjectmaternal syphilisen
dc.subjectpregnant womenen
dc.subjectrapid testen
dc.subjectsyphilis screening.en
dc.titleCost-Effectiveness Analysis of Point-of-Care Rapid Testing Versus Laboratory-Based Testing for Antenatal Screening of Syphilis in Brazil
dc.typeArticle
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