Cost-effectiveness of treatment strategies for cervical infection among women at high risk in Madagascar.
BACKGROUND
According to the national guidelines developed in 2001, a woman at high risk of gonorrhea and chlamydia in Madagascar is treated presumptively at her first sexually transmitted infection clinic visit; risk-based treatment (RB) is subsequently used at 3-month visits.


OBJECTIVE
To compare health and economic outcomes for a 2-stage Markov process with the following 3 cervical infection treatment policies at baseline and at 3-month follow-up visit: presumptive treatment (PT), RB, and an interim laboratory/risk-based policy.


METHODS
Cost-effectiveness analysis was used to compare the 9 treatment strategies.


RESULTS
When 3-month incidence of cervical infection is <20%, the national guidelines are less costly and less effective than both RB followed by PT, and PT at both visits.


CONCLUSIONS
The national guidelines are a reasonable strategy, especially in the context of resource constraints, relatively low reinfection rates, and local preferences.
McClamroch
Kristi
K
Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Rensselaer, New York, USA. kmcclamroch@albany.edu
Behets
Frieda
F
Van Damme
Kathleen
K
Rabenja
Lovaniaina Ny
LN
Myers
Evan
E
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D009313:National Health Programs / Q000592:standards; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002577:Uterine Cervical Diseases / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control