title: Cost-effectiveness of treatment strategies for cervical infection among women at high risk in Madagascar.
abstract: 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.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Rensselaer, New York, USA. kmcclamroch@albany.edu
authors.forename: Kristi
authors.initials: K
authors.lastname: McClamroch
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
authors.forename: Kathleen
authors.initials: K
authors.lastname: Van Damme
authors.forename: Lovaniaina Ny
authors.initials: LN
authors.lastname: Rabenja
authors.forename: Evan
authors.initials: E
authors.lastname: Myers
mesh_terms: 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