Cost-effectiveness of different screening and diagnostic strategies for sexually transmitted infections and bacterial vaginosis in women

Genital inflammation associated with sexually transmitted infections (STIs) and Bacterial Vaginosis (BV) is considered a key driver in the HIV/AIDS epidemic. A new rapid point-of-care (POC) test that detects genital inflammation in women was recently developed by researchers at the University of Cape Town. The objective of this study was to establish the cost-effectiveness of this novel intervention in comparison to other relevant screening and diagnostic strategies for the management of STIs and BV in women. It follows prior research on the cost and affordability of national implementation of screening with this technology. This research indicated that it might not affordable policy option given current health budget constraints. A decision analysis model was developed to estimate the cost and health outcomes associated with five different screening and diagnostic strategies for women seeking care in the South African public health sector. A decision tree was constructed, and all cost and effectiveness parameters were obtained from published and unpublished literature. The model incorporated all clinic-level and treatment costs associated with diagnosing and treating a single episode of disease. The main outcome measure was the effectiveness of each approach in correctly diagnosing an STI or BV in women, proxied by its sensitivity measure. One-way sensitivity analyses and threshold analysis were conducted to test key uncertainties and assumptions in the model. In the base-case scenario, screening with GIFT and treating GIFT-positive cases based on syndromic management guidelines, was the most cost-effective strategy with an ICER of $2.60 per women diagnosed with an STI(s) and/or BV. This strategy remained the most cost-effective even when a variety of parameters were varied in one-way sensitivity analyses. A threshold analyses on GIFT's sensitivity revealed that the strategy would remain the most cost-effective unless the sensitivity of the test assay decreased below 14.83%. From the perspective of the South African government, screening with GIFT and treating positive cases according to syndromic management guidelines is a highly cost-effective strategy for the management of STIs and BV in women in the reproductive age, but affordability considerations cannot be ignored. The newly developed rapid POC can significantly improve the management of STIs and BV in women through identifying asymptomatic women and at the same time, reducing their risk of HIV infection, but further research is required to inform decision-making.

Grantor

Health Economics Unit

Year dc:date.issued

2020

Author dc:creator

• van Der Walt, Elise

Advisor dc:contributor.advisor

• Sinanovic, Edina

• Health Economics

Handle dc:identifier.uri

http://hdl.handle.net/11427/33088

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/33088