A Comparison of Cost-Effectiveness of Three Protocols for Diagnosis and Treatment of Gonococcal and Chlamydial Infections in Women in Africa

• Published in: Sexually transmitted diseases 2003-05, Vol.30 (5), p.455-469
• Main Authors: SAHIN-HODOGLUGIL, NURIYE NALAN, WOODS, REBECCA, PETTIFOR, AUDREY, WALSH, JULIA
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Africa; Anti-Bacterial Agents - therapeutic use; Azithromycin - therapeutic use; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Chlamydiaceae Infections - diagnosis; Chlamydiaceae Infections - drug therapy; Chlamydiaceae Infections - economics; Clinical Protocols; Comparative analysis; Cost-Benefit Analysis - economics; Costs; Decision Trees; Doxycycline - therapeutic use; Female; Gonorrhea - diagnosis; Gonorrhea - drug therapy; Gonorrhea - economics; Human bacterial diseases; Humans; Infectious diseases; Medical diagnosis; Medical sciences; Multivariate Analysis; Sexually transmitted diseases; STD; Tropical medicine; Uterine Cervicitis - diagnosis; Uterine Cervicitis - drug therapy; Uterine Cervicitis - economics; Women
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/00007435-200305000-00014

Background: The cost-effectiveness of different STD diagnosis and treatment approaches has not been evaluated previously. Goals: The goals of the study were to compare the cost-effectiveness of "gold standard" care (GS), syndromic management (SM), and mass treatment (MT) protocols for the treatment of cervical gonococcal and chlamydial infections in a hypothetical model of 1 million women in Africa. Study Design: A decision tree model was constructed for each of the protocols. Sensitivity analyses were conducted and 10,000 Monte Carlo simulations were run to test the robustness of the cost-effectiveness estimates to changes in underlying assumptions. Results: MT with doxycycline for chlamydia was the most costeffective protocol in terms of cost per cure. SM protocol had the lowest total programmatic costs. For the GS protocol, using azithromycin for chlamydial infections was found to be more cost-effective than using doxycycline. For both the GS and SM protocols, the total cost of the program was most sensitive to the percentage of women seeking STD treatment and the prevalence of non-STD vaginal discharge, whereas the cost of MT was almost exclusively determined by coverage rates. Conclusions: No single protocol carries with it all the desired con ditions of an optimal cost-effective program. The treatment-seeking behavior, STD prevalence, and coverage of each locale must be eval uated to determine the most cost-effective and highest impact pro gram. MT was found to be the most cost-effective protocol in terms of cost per woman treated when compared with the SM and GS protocols for STDs in women.