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The cost-effectiveness of syndromic management for male STD patients with urethral discharge symptoms and genital ulcer disease in Taiwan
  1. Ching-Hui Tsai
  1. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    1. Ta-Chung Lee
    1. Department of Rehabilitation, Chiali General Hospital, Tainan, Taiwan
      1. Hsiao-Ling Chang
      1. Division of Surveillance, Center for Disease Control, Department of Health, Taipei, Taiwan
        1. Li-Hui Tang
        1. Center for Disease Control, Department of Health, Taipei, Taiwan
          1. Chien-Chou Chiang
          1. Taipei City STD Control Center, Taipei, Taiwan
            1. Kow-Tong Chen (ktchen{at}mail.ncku.edu.tw)
            1. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

              Abstract

              Objective: We assessed the cost-effectiveness of syndromic management for the treatment of STDs in comparison with the strategies currently used in STD clinics in Taiwan.

              Methods: During the period between July 2004 and June 2005, all male patients with genitourinary symptoms attending two hospitals were included in this study. Current clinical procedures (presumptive treatment and laboratory tests), etiological diagnosis, and syndromic management were compared in terms of diagnostic accuracy, treatment appropriateness, costs, and effectiveness.

              Results: A total of 473 patients met the inclusion criteria and were enrolled in the study. Three-hundred thirty-five patients (71%) had urethral symptoms (discharge, dysuria or painful urination), and 138 (29%) had genital ulcers, sores and skin rashes. For the current approach, the sensitivity, specificity and positive predictive value (PPV) for detection of chlamydial, gonococcal, and combined forms of infection was 100%, 40.0% and 60.4%, respectively. In contrast, the sensitivity, specificity, and PPV for detection of syphilis detection was 100%, 86.7% and 70.2%, respectively. For syndromic management, the sensitivity, specificity, and PPV detection of chlamydial, gonococcal, and combined forms of infection were 85.0%, 40.0% and 56.4%, respectively. In contrast, the sensitivity, specificity, and PPV for detection of syphilis were 78.8%, 18.1%, and 23.2%, respectively. The average cost (in US dollars) for implementing a correct treatment using the current approach was $54.27 and $30.74 for urethritis and syphilis, respectively. For the etiological approach, the average cost for implementing a correct treatment was $32.83 and $21.58 for urethritis and syphilis, respectively. For the syndromic approach, the average cost for a correct treatment was $3.86 and $14.30 for urethritis and syphilis, respectively.

              Conclusions: In this sample of patients attending STD clinics in Taiwan, syndromic management was found to be a more cost-effective protocol in terms of cost per treated STD patient when compared to the current and etiological protocols for STDs.

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