Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018

Abstract

Background The purpose of this study was to estimate the health impact of syphilis in the United States in terms of the number of quality-adjusted life years (QALYs) lost attributable to infections in 2018. Methods We developed a Markov model which simulates the natural history and management of syphilis. The model was parameterized by sex and sexual orientation (women who have sex with men, men who have sex with women[MSW], and men who have sex with men[MSM]), and by age at primary infection. We developed a separate decision tree model to quantify health losses due to congenital syphilis. We estimated the average lifetime number of QALYs lost per infection, and the total expected lifetime number of QALYs lost due to syphilis acquired in 2018. Results We estimated the average number of discounted lifetime QALYs lost per infection as 0.09 [0.03-0.19 95% uncertainty interval (UI)]. The total expected number of QALYs lost due to syphilis acquired in 2018 was 13,349[5,071-31,360]. While per-case loss was the lowest among MSM(0.06), MSM accounted for 47.7% of the overall burden. For each case of congenital syphilis, we estimated 1.79[1.43-2.16] and 0.06[0.01-0.14] QALYs lost in the child and the mother, respectively. We projected 2,332[1,871-2,825] and 79[17-177] QALYs lost for children and mothers, respectively, due to congenital syphilis in 2018. Conclusions Syphilis causes substantial health losses in adults and children. Quantifying these health losses in terms of QALYs can inform cost-effectiveness analyses and can facilitate comparisons of the burden of syphilis to that of other diseases.

The Estimated Lifetime Quality-Adjusted Life-Years Lost Due to Chlamydia, Gonorrhea, and Trichomoniasis in the United States in 2018

“…On both a per-infection basis and in terms of total aggregate QALYs lost nationwide, chlamydia imposed the greatest burden, followed by gonorrhea, then trichomoniasis. Published estimates of the QALYs lost in the United States due to syphilis [ 31 ] suggest that syphilis has a higher QALY lost per infection (0.09; 95% UI, 0.03–0.19) than the 3 STIs we examined, and that syphilis is the second only to chlamydia in terms of the aggregate QALYs lost nationwide (13 349; 95% UI, 5071–31 360).…”

Lifetime quality-adjusted life years lost due to genital herpes acquired in the United States in 2018: a mathematical modeling study

“…Our estimates can be used to compare the burden of GH infection to other STIs and infections. On a per-infection basis, the estimated average number of QALYs lost due to GH (0.05 QALYs) is smaller than that due to HIV (5.80 QALYs), 58 , 59 syphilis (0.09 QALYs), 60 and gonorrhoea (among women, 0.09 QALYs), 61 while the burden of GH is higher than that of per gonorrhoea infection among men (0.0015-0.002 QALYs) 61 and per case of genital warts (0.024 QALYs). 62 , 63 , 64 At the population level, the estimated total quality-of-life burden due to GH in the US (33,100 QALYs) exceeds that of syphilis (13,300 QALYs), 60 mainly due to the higher incidence of GH.…”

Factors associated with adverse pregnancy outcomes of maternal syphilis in Henan, China, 2016–2022

“…Maternal syphilis can cause severe harm to pregnant women, foetuses, and infants. It not only severely affects the quality of life of pregnant women [ 1 ] but also may lead to adverse pregnancy outcomes (APOs), such as preterm birth, stillbirth, and congenital syphilis [ 2 , 3 ]. Studies showed that the incidence of APOs in pregnant women infected with syphilis was significantly higher than that in pregnant women without syphilis [ 4 , 5 ].…”