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Repeat Screening for Syphilis in the Third Trimester of Pregnancy: A Cost-Effectiveness Analysis

Hersh, Alyssa R., BA, BS; Megli, Christina J., MD, PhD; Caughey, Aaron B., MD, PhD

doi: 10.1097/AOG.0000000000002795
Infectious Disease: Original Research: PDF Only

OBJECTIVE: To estimate the cost-effectiveness of screening all women during the first and third trimesters compared with screening just once during pregnancy.

METHODS: We used a theoretical cohort of 3.9 million women in the United States to model syphilis screening approaches in pregnancy, particularly comparing one-time screening with repeat third-trimester screening. Outcomes of syphilis infection included in the model were congenital syphilis, intrauterine fetal demise, neonatal death, and total quality-adjusted life-years (QALYs). Probabilities, utilities, and costs were obtained from the literature, and a cost-effectiveness threshold was set at $100,000 per QALY. A societal perspective was assumed.

RESULTS: Our model demonstrated that repeat screening in the third trimester for syphilis in pregnancy will result in fewer maternal and neonatal adverse outcomes and higher QALYs when compared with screening once in the first trimester. Specifically, we demonstrated that repeat screening results in 41 fewer neonates with evidence of congenital syphilis, 73 fewer cases of intrauterine fetal demise, 27 fewer neonatal and infant deaths, in addition to a cost savings of $52 million and 4,000 additional QALYs.

CONCLUSION: Using our baseline assumptions, our data support that in pregnancy, repeat screening for syphilis is superior to single screening during the first trimester and is both cost-effective and results in improvement in maternal and neonatal outcomes. When screening policies are being created for pregnant women, the cost-effectiveness of repeat screening for syphilis should be considered.

Universal repeat screening for syphilis in the third trimester of pregnancy is cost-effective and results in improved maternal and neonatal outcomes.

Oregon Health & Science University, Portland, Oregon; and the University of Pittsburgh, Pittsburgh, Pennsylvania.

Corresponding author: Alyssa R. Hersh, BA, BS, c/o Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239; email: hersha@ohsu.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received March 12, 2018

Received in revised form May 13, 2018

Accepted June 07, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.