title: Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China.
abstract: BACKGROUND
  In China, recent rises in syphilis and HIV cases have increased the focus on preventing mother-to-child transmission of these infections. We assess the health and economic outcomes of different strategies of prenatal HIV and syphilis screening from the local health department's perspective.
  
  
  METHODS
  A Markov cohort decision analysis model was used to estimate the health and economic outcomes of pregnancy using disease prevalence and cost data from local sources and, if unavailable, from published literature. Adverse pregnancy outcomes included induced abortion, stillbirth, low birth weight, neonatal death, congenital syphilis in live-born infants, and perinatal HIV infection. We examined 4 screening strategies: no screening, screening for HIV only, for syphilis only, and for both HIV and syphilis. We estimated disability-adjusted life years (DALYs) for each health outcome using life expectancies and infections for mothers and newborns.
  
  
  RESULTS
  For a simulated cohort of 10,000 pregnant women (0.07% prevalence for HIV and 0.25% for syphilis; 10% of HIV-positives were coinfected with syphilis), the estimated costs per DALY prevented were as follows: syphilis-only, $168; HIV-and-syphilis, $359; and HIV-only, $5636. The estimated incremental cost-effectiveness ratio if an existing HIV-only strategy added syphilis screening (i.e., move from the HIV-only strategy to the HIV-and-syphilis strategy) was $140 per additional DALY prevented.
  
  
  CONCLUSIONS
  Given the increasing prevalence of syphilis and HIV among pregnant women in China, prenatal HIV screening programs that also include syphilis screening are likely to be substantially more cost-effective than HIV screening alone and prevent many more adverse pregnancy outcomes.
authors.affiliation: From the *Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta GA; †National Center for Women and Children's Health, China CDC, Beijing, China; ‡Office of the Director, Center for Global Health, CDC, Atlanta, GA; §CDC Global AIDS Program, China Office, Beijing, China; ¶Association of Schools of Public Health, Washington, DC; and ∥Division of Global HIV/AIDS, Center for Global Health, CDC, Atlanta, GA.
authors.forename: Kwame
authors.initials: K
authors.lastname: Owusu-Edusei
authors.forename: Guoyu
authors.initials: G
authors.lastname: Tao
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gift
authors.forename: Ailing
authors.initials: A
authors.lastname: Wang
authors.forename: Linhong
authors.initials: L
authors.lastname: Wang
authors.forename: Ye
authors.initials: Y
authors.lastname: Tun
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Wei
authors.forename: Liming
authors.initials: L
authors.lastname: Wang
authors.forename: Serena
authors.initials: S
authors.lastname: Fuller
authors.forename: Mary L
authors.initials: ML
authors.lastname: Kamb
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D008403:Mass Screening / Q000191:economics*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000191:economics; D011296:Prenatal Diagnosis / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012959:Socioeconomic Factors; D013587:Syphilis / Q000191:economics / Q000517:prevention & control* / Q000635:transmission