Serologic Testing for Syphilis in the United States: A Cost-Effectiveness Analysis of Two Screening Algorithms

Background: The introduction of automated treponemal enzyme immunoassays and chemiluminescence assays (EIA/CA) tests has led some laboratories in the United States to use new syphilis screening algorithms that start with a treponemal test. We compared the economic and health outcomes of this new alg...

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Bibliographic Details
Published in:Sexually transmitted diseases 2011-01, Vol.38 (1), p.1-7
Main Authors: Owusu-Edusei, Kwame, Peterman, Thomas A., Ballard, Ronald C.
Format: Article
Language:English
Subjects:
Algorithms
Bacterial diseases
Bacterial diseases of the genital system
Benefit cost analysis
Biological and medical sciences
Cost-Benefit Analysis
Enzymes
General aspects
Human bacterial diseases
Human infectious diseases. Experimental studies and models
Humans
Immunoassay
Infectious diseases
Mass Screening - economics
Mass Screening - methods
Medical sciences
Medical tests
Original Study
Plasma - immunology
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Reagins - blood
Sensitivity and Specificity
Syphilis
Syphilis - diagnosis
Syphilis - drug therapy
Syphilis - economics
Syphilis - epidemiology
Syphilis Serodiagnosis - economics
Syphilis Serodiagnosis - methods
Treatment Outcome
Treponema pallidum - immunology
Treponema pallidum - isolation & purification
United States - epidemiology
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Summary:Background: The introduction of automated treponemal enzyme immunoassays and chemiluminescence assays (EIA/CA) tests has led some laboratories in the United States to use new syphilis screening algorithms that start with a treponemal test. We compared the economic and health outcomes of this new algorithm with the standard algorithm from the perspective of the United States health system. Methods: We used a cohort decision analysis to estimate the expected costs and effects (including follow-ups and overtreatment) of the 2 algorithms from a health-care system perspective. In the standard algorithm, rapid plasma reagin (RPR) is followed (if reactive) by EIA/CA (Nontreponemal-First). In the new algorithm, EIA/CA is followed (if reactive) by RPR. If the RPR is negative, Treponema pallidum passive particle agglutination assay (TP-PA) test is used (Treponemal-First). Results: For a cohort of 200,000 individuals (1000 current infections and 10,000 previous infections), the net costs were $1.6 m (Treponemal-First) and $1.4 m (Nontreponemal-First). The Treponemal-First option treated 118 more cases (986 vs. 868) but resulted in a substantially higher number of follow-ups ( 11,450 vs. 3756) and overtreatment (964 vs. 38). Treating the additional 118 cases might prevent 1 case of tertiary syphilis. The estimated cost-effectiveness ratios were $1671 (Treponemal-First) and $1621 (Nontreponemal-First) per case treated. The overtreatment was a function of the specificity of the EIA/CA and the lack of independence of EIA/CA and TP-PA. Conclusion: The Treponemal-First option costs slightly more and results in more unnecessary treatment.
ISSN:0148-5717
1537-4521
DOI:10.1097/OLQ.0b013e3181ec51f1