Sweeney Sedona, Mosha Jacklin F, Terris-Prestholt Fern, Sollis Kimberly A, Kelly Helen, Changalucha John, Peeling Rosanna W
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
Health Policy Plan. 2014 Aug;29(5):633-41. doi: 10.1093/heapol/czt049. Epub 2013 Jul 27.
To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation.
The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty.
In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel.
Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out.
确定在坦桑尼亚实施快速梅毒检测（RST）与快速血浆反应素试验（RPR）相比的成本，并确定质量保证（QA）系统对RST实施成本的相对影响。
在随后几年中，从坦桑尼亚盖塔区现有产前保健机构中收集了9个月的RPR和RST筛查项目的增量成本，这些机构在规模、偏远程度和产前服务范围方面各不相同。估算了每个机构中接受检测和治疗的每位女性的成本。构建了敏感性分析以确定参数和模型不确定性的影响。
在接受调查的机构中，共有6362名女性接受了RST检测，相比之下，224名女性接受了RPR检测。筛查每位女性的单位成本范围为1.76美元至3.13美元，治疗每位女性的单位成本范围为12.88美元至32.67美元。QA系统的单位成本为每位接受检测的女性0.51美元，其中50%归因于项目人员的工资和交通费用。
我们的结果表明，在这种情况下，快速梅毒诊断非常便宜，并且可以克服确保普遍获得梅毒检测和治疗的一些关键障碍。发现实施质量体系的额外成本相对较小，并且可以通过改变项目设计来降低。鉴于质量体系有可能提高诊断和护理质量，我们建议将QA活动纳入RST的推广中。
