Cost-Effectiveness of a Dual Non-Treponemal/Treponemal Syphilis Point-of-Care Test to Prevent Adverse Pregnancy Outcomes in Sub-Saharan Africa

Owusu-Edusei, Kwame; Gift, Thomas L.; Ballard, Ronald C.

doi:10.1097/olq.0b013e3182260987

Cited by 54 publications

(105 citation statements)

References 28 publications

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“…All of these previously published estimates fall within the bounds of our 95% confidence intervals. More recent analyses that evaluated the cost-effectiveness of antenatal syphilis screening using the ICS test are available for Tanzania (ICER: US$12–US$17 [34]) and for SSA in general [7],[35]. The studies for SSA found that screening was cost-saving, e.g., it was associated with lower cost as well as improved outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Second, antibiotic therapy may also reduce the incidence of other relevant clinical end points such as miscarriage, spontaneous abortion, or low birth weight, which are not included in our model. Third, unlike other studies published in the relevant literature [7],[35], we did not model lifetime treatment costs associated with congenital syphilis. Infants born with congenital syphilis may experience complications of the disease that can result in increased direct medical costs over their lifetime, in which case screening may partially offset these costs or even result in a net cost saving.…”

Section: Discussionmentioning

confidence: 99%

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Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

et al. 2013

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“…Owusu-Edesei and colleagues recently reported that a screening strategy employing an ICS TT cost less than a dual-POCT (TT and NTT) strategy in a high-prevalence setting but that the dual-POCT strategy may significantly reduce overtreatment (68). No cost-effectiveness data are available for developed countries.…”

Section: Poctmentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

167

156

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bComplexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests.

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“…10,11 Since then, newer, rapid and affordable POCTs for syphilis have become available and are in use in several developing countries. 12,13 The need to develop more POCTs for use in all settings, including the industrialised world, is an imperative. Though this need is recognised, perceptions of the qualities that describe the desired POCTs for STIs differ between frontline clinicians and the industry professionals who are charged with developing and marketing these tests.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care tests for sexually transmissible infections: what do ‘end users' want?

Rompalo

Hsieh²,

Hogan

et al. 2013

Sex. Health

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Background Clinicians and developers identify sensitivity as an important quality in a point-of-care test (POCT) for sexually transmissible infections (STIs). Little information exists regarding what patients want for STI POCTs. Methods A qualitative study, encompassing five focus groups among attendees of STI and adolescent health centres in Baltimore, Maryland, and Cincinnati, Ohio, were conducted between March 2008 and April 2009. Discussion topics included advantages and disadvantages of having a POCT, perceived barriers to using POCTs in the clinic setting and at home, priorities for the development of new POCTs for STIs, and envisioned characteristics of an ideal POCT. All discussions were recorded and transcribed. A qualitative content analysis was performed to examine frequencies or patterns of recurring codes, which were regrouped and indexed to identify salient themes. Results Patients attending STI and adolescent outpatient clinics are in favour of diagnostic tests that are rapid, easy to read and simple to use. Home testing options for POCTs were acceptable and provided better confidentiality, privacy and convenience, but clinic-based POCTs were also acceptable because they offer definitive results and ensure immediate treatment. Barriers to home POCTs centred on cost and the ability to read and perform the test correctly at home. Opinions did not differ by patient ethnicity, except that Hispanic participants questioned the reliability of home test results, wanted high sensitivity and desired bilingual instructions. Conclusions Patients attending STI and adolescent medical centres are in favour of STI POCTs if they are affordable, rapid, easy to read and simple to use.

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Cost-Effectiveness of a Dual Non-Treponemal/Treponemal Syphilis Point-of-Care Test to Prevent Adverse Pregnancy Outcomes in Sub-Saharan Africa

Abstract: The dual-POC test may help save cost in resource-poor settings where disease prevalence (and loss to follow-up) is high, while substantially reducing overtreatment.

Cited by 54 publications

References 28 publications

Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

Recent Trends in the Serologic Diagnosis of Syphilis

Point-of-care tests for sexually transmissible infections: what do ‘end users' want?

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