Cost-effectiveness analysis of annual Trichomonas vaginalis screening and treatment in HIV-positive women to prevent HIV transmission.
BACKGROUND
Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women.


METHODS
A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations.


RESULTS
Annual Trichomonas screening and treatment saves US $553 (US $475- US $645) per woman in the prevention of HIV transmission to male partners. The cost-effectiveness of this strategy was maintained across all assumptions in a sensitivity analysis.


CONCLUSIONS
Trichomonas screening and treatment for the purpose of decreasing new HIV infections is not only cost-effective but also cost saving in HIV-positive women. If Centers for Disease Control and Prevention treatment guidelines were followed in all HIV-positive women living in the United States, the lifetime cost of new HIV infections prevented would approximate US $159,264,000 and could potentially prevent new HIV cases secondary to female-to-male transmissions.
From the *Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; †Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, Southern Illinois University, Carbondale, IL; and Departments of ‡Pediatrics and §Health Science and Research, Medical University of South Carolina, Charleston, SC.
Gweneth Bratton
GB
Lazenby
Elizabeth Ramsey
ER
Unal
Annie Lintzenich
AL
Andrews
Kit
K
Simpson
D000328:Adult; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008795:Metronidazole / Q000191:economics / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D014246:Trichomonas vaginalis / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology
D000890:Anti-Infective Agents; D008795:Metronidazole