Schackman Bruce R, Neukermans Christopher P, Fontain Sandy N Nerette, Nolte Claudine, Joseph Patrice, Pape Jean W, Fitzgerald Daniel W
Department of Public Health, Weill Medical College, Cornell University, New York, New York, United States of America.
PLoS Med. 2007 May;4(5):e183. doi: 10.1371/journal.pmed.0040183.
New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled-up prenatal testing to prevent mother-to-child HIV transmission in Haiti.
A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance (rural standard of care), rapid plasma reagin test with results and treatment at 1-wk follow-up (urban standard of care), and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization-Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years (DALYs) of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost-effectiveness ratios are in US dollars/DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost-effectiveness ratio of $6.83/DALY in rural settings and $9.95/DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow-up visits. Integrating rapid syphilis testing into a scaled-up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $525,000.
In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost-effective. A similar approach may be beneficial in other resource-poor countries that are scaling up prenatal HIV testing.
新型快速梅毒检测可在单次门诊就诊时实现简单、即时的诊断与治疗。我们比较了在海地扩大产前检测以预防母婴传播艾滋病毒的过程中，使用快速梅毒检测对孕妇进行筛查的成本效益、预期健康结果及年度成本。
一个决策分析模型分别模拟了农村和城市地区孕妇的健康结果及成本。我们比较了梅毒症状监测（农村护理标准）、快速血浆反应素试验及1周随访时的结果与治疗（城市护理标准），以及一种能即时出结果并进行治疗的新型快速检测。检测性能数据来自世界卫生组织热带病研究和培训特别规划在太子港的GHESKIO中心（海地卡波西肉瘤和机会性感染研究小组）进行的一项现场试验。健康结果是根据产前梅毒治疗疗效的历史数据预测得出的，包括新生儿的伤残调整生命年（DALYs）、先天性梅毒病例、新生儿死亡和死产。从社会角度来看，成本效益比以美元/伤残调整生命年为单位；从支付方角度来看，年度成本以美元为单位。即时治疗的快速检测在农村地区的成本效益比为6.83美元/伤残调整生命年，在城市地区为9.95美元/伤残调整生命年。结果对地区梅毒患病率、快速检测灵敏度及随访复诊率敏感。将快速梅毒检测纳入扩大的国家艾滋病毒检测和产前护理计划，每年可预防1125例先天性梅毒病例以及1223例死产或新生儿死亡，成本为525,000美元。
在海地，将新型快速梅毒检测纳入产前护理和艾滋病毒检测可预防先天性梅毒病例和死产，且具有成本效益。类似方法可能对其他正在扩大产前艾滋病毒检测的资源匮乏国家有益。
