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Cost-effectiveness of Integrated Routine Offering of Prenatal HIV and Syphilis Screening in China

Owusu-Edusei, Kwame Jr PhD, PMP*; Tao, Guoyu PhD*; Gift, Thomas L. PhD*; Wang, Ailing MD; Wang, Linhong MD; Tun, Ye PhD; Wei, XiaoYu MPH§; Wang, LiMing MD§; Fuller, Serena MPH§¶; Kamb, Mary L. MD*; Bulterys, Marc MD§∥

doi: 10.1097/OLQ.0000000000000085
Original Study

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.

Integrated routine HIV and syphilis screening among pregnant women in China was more cost-effective than HIV screening alone and prevented many more adverse pregnancy outcomes.

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

Acknowledgments: Staff of the National Center for HIV/STD Prevention and Control and the National Center for Women and Children’s Health of the China CDC were helpful in the conduct of this analysis. The authors also thank UNICEF-China and WHO-China for the encouragement. The authors are particularly grateful to Professor Gui Xien of Wuhan University for helpful discussions. In addition, Chin-Yih Ou, Sujian Situ, and Christine Korhonen at the CDC Global AIDS Program in China provided useful suggestions on an earlier draft.

Conflict of interest statements: None.

Funding: None.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the United States Centers for Disease Control and Prevention (CDC). Mention of company names or products does not imply endorsement by CDC.

Correspondence: Kwame Owusu-Edusei Jr, PhD, PMP, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd MS E-80, Atlanta, GA 30333. E-mail:

Received for publication May 7, 2013, and accepted December 2, 2013.

© Copyright 2014 American Sexually Transmitted Diseases Association