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Cost-Effectiveness of On-Site Antenatal Screening to Prevent Congenital Syphilis in Rural Eastern Cape Province, Republic of South Africa

Blandford, John M. PhD*; Gift, Thomas L. PhD*; Vasaikar, Sandeep PhD; Mwesigwa-Kayongo, Dan MD; Dlali, Pumla MS; Bronzan, Rachel N. MD*

Sexually Transmitted Diseases: July 2007 - Volume 34 - Issue 7 - p S61-S66
doi: 10.1097/01.olq.0000258314.20752.5f

Objectives: On-site screening and same-day treatment of maternal syphilis in underresourced settings can avert greater numbers of congenital syphilis cases, but health outcomes and associated costs must be evaluated jointly.

Methods: We used decision analysis to estimate the incremental cost-effectiveness of two on-site antenatal syphilis screening strategies to avert congenital infections—qualitative RPR (on-site RPR) and treponemal immunochromatographic strip assay (on-site ICS)—compared to the current practice (off-site RPR/TPHA).

Findings: With antenatal active syphilis prevalence of 6.3%, the incremental cost-effectiveness of on-site ICS in averting congenital infections was estimated to be USD104, averting 82% of cases expected in absence of a program. The incremental cost-effectiveness of off-site RPR/TPHA was USD82 but would avert only 55% of congenital syphilis cases. On-site RPR was dominated by the other screening strategies.

Conclusions: In settings of high maternal syphilis prevalence, on-site antenatal screening with ICS is a cost-effective approach to reduce the incidence of congenital syphilis.

A cost-effectiveness analysis of antenatal syphilis screening programs in rural South Africa found that on-site screening and treatment to prevent congenital transmission may be cost-effective in underresourced settings.

From the *Centers for Disease Control and Prevention, Atlanta, Georgia; and †University of Transkei (UNITRA), Umtata, Eastern Cape Province, South Africa

The authors acknowledge George P. Schmid, MD, MSc; Stuart M. Berman, MD, ScM; and Caroline A. Ryan, MD, MPH, for advice on estimating adverse outcomes of congenital syphilis infections; and Kathleen L. Irwin, MD, MPH, for critical review of the manuscript.

This study was supported by the US Centers for Disease Control and Prevention.

The authors have had full control of all primary data throughout the study, analysis, and writing period.

Correspondence: John M. Blandford, PhD, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-30, Atlanta, GA 30333. E-mail:

Received for publication June 28, 2006, and accepted November 29, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association