title: The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia.
abstract: OBJECTIVE
  Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women.
  
  
  METHODS
  Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results.
  
  
  RESULTS
  Although this analysis found screening using RPR to be relatively cheap, most (>70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women.
  
  
  CONCLUSIONS
  This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. Electronic address: fern.terris-prestholt@lshtm.ac.uk.
authors.forename: Fern
authors.initials: F
authors.lastname: Terris-Prestholt
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK; University of Bristol, Bristol, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sergio
authors.initials: S
authors.lastname: Torres-Rueda
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Santesso
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sedona
authors.initials: S
authors.lastname: Sweeney
authors.affiliation: Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Patricia
authors.initials: P
authors.lastname: Mallma
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Katharine D
authors.initials: KD
authors.lastname: Shelley
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Garcia
authors.affiliation: Health and Development International, Newburyport, MA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bronzan
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Gill
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Broutet
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Teodora
authors.initials: T
authors.lastname: Wi
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Rosanna W
authors.initials: RW
authors.lastname: Peeling
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Lori
authors.initials: L
authors.lastname: Newman
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D010568:Peru; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011296:Prenatal Diagnosis / Q000191:economics* / Q000379:methods; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy; D013588:Syphilis Serodiagnosis / Q000191:economics* / Q000379:methods; D013636:Tanzania; D015024:Zambia
keywords: Africa; Cost-effectiveness analysis; Diagnostic algorithms; Latin America; Syphilis screening and treatment