title: A comparison of cost-effectiveness of three protocols for diagnosis and treatment of gonococcal and chlamydial infections in women in Africa.
abstract: BACKGROUND
  The cost-effectiveness of different STD diagnosis and treatment approaches has not been evaluated previously.
  
  
  OBJECTIVE
  The goals of the study were to compare the cost-effectiveness of "gold standard" care (GS), syndromic management (SM), and mass treatment (MT) protocols for the treatment of cervical gonococcal and chlamydial infections in a hypothetical model of 1 million women in Africa.
  
  
  METHODS
  A decision tree model was constructed for each of the protocols. Sensitivity analyses were conducted and 10,000 Monte Carlo simulations were run to test the robustness of the cost-effectiveness estimates to changes in underlying assumptions.
  
  
  RESULTS
  MT with doxycycline for chlamydia was the most cost-effective protocol in terms of cost per cure. SM protocol had the lowest total programmatic costs. For the GS protocol, using azithromycin for chlamydial infections was found to be more cost-effective than using doxycycline. For both the GS and SM protocols, the total cost of the program was most sensitive to the percentage of women seeking STD treatment and the prevalence of non-STD vaginal discharge, whereas the cost of MT was almost exclusively determined by coverage rates.
  
  
  CONCLUSIONS
  No single protocol carries with it all the desired conditions of an optimal cost-effective program. The treatment-seeking behavior, STD prevalence, and coverage of each locale must be evaluated to determine the most cost-effective and highest impact program. MT was found to be the most cost-effective protocol in terms of cost per woman treated when compared with the SM and GS protocols for STDs in women.
authors.affiliation: University of California, Berkeley, Bay Area International Group (BIG), 1131 Tolman Hall, Berkeley, CA 94720-7360, USA. nuriye@uclink.berkeley.edu
authors.forename: Nuriye Nalan
authors.initials: NN
authors.lastname: Sahin-Hodoglugil
authors.forename: Rebecca
authors.initials: R
authors.lastname: Woods
authors.forename: Audrey
authors.initials: A
authors.lastname: Pettifor
authors.forename: Julia
authors.initials: J
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002694:Chlamydiaceae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis / Q000191:economics*; D003663:Decision Trees; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D015999:Multivariate Analysis; D002575:Uterine Cervicitis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline