The Kirby Institute, University of New South Wales, Sydney, Australia.
The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
PLoS One. 2021 Jun 17;16(6):e0253135. doi: 10.1371/journal.pone.0253135. eCollection 2021.
Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries.
Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists.
Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards.
Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.
性传播和生殖系统感染与妊娠不良结局和分娩不良结局有关。在单次产前就诊时进行即时检测可方便检测和治疗，并可能降低不良结局的风险。成功实施和扩大规模取决于了解此类方案的比较效果及其相对成本和成本效益。本系统评价综合评估了中低收入国家孕妇性传播和生殖系统感染即时检测和治疗的经济评价证据。
使用预先确定的标准全面检索了 Medline、Embase 和 Web of Science 数据库。通过搜索 Google Scholar 和所有纳入研究的参考文献，确定了其他文献。如果经济评价是在中低收入国家进行的，并评估了梅毒、衣原体、淋病、滴虫病和/或细菌性阴道病的产前即时检测和治疗，则符合纳入标准。使用叙述性综合方法分析研究。使用两份已发表的清单评估方法学和报告标准。
本综述纳入了 16 项经济评价；其中 10 项来自非洲，3 项来自拉丁美洲和南美洲，3 项是跨大陆比较。15 项研究评估了梅毒即时检测和治疗，1 项评估了衣原体。成本和成本效益的关键驱动因素包括疾病流行率；检测、治疗和人员成本；检测敏感性和特异性；以及筛查和治疗覆盖率。所有研究均达到了 Drummond 清单的 75%或以上标准，以及综合卫生经济学评估报告标准的 60%。
总体而言，与不筛查、综合征管理和基于实验室的检测相比，即时检测和治疗具有成本效益。未来的经济评价应考虑其他常见感染及其对母婴的终生影响。补充负担能力和公平性分析将为更多投资于产前即时检测和治疗性传播和生殖系统感染提供更强有力的理由。
