Article Text

The cost-effectiveness of syndromic management for male sexually transmitted disease patients with urethral discharge symptoms and genital ulcer disease in Taiwan
1. C-H Tsai1,
2. T-C Lee2,
3. H-L Chang3,4,
4. L-H Tang5,
5. C-C Chiang6,
6. K-T Chen1
1. 1
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2. 2
Department of Rehabilitation, Chiali General Hospital, Tainan, Taiwan
3. 3
Division of Surveillance, Center for Disease Control, Department of Health, Taipei, Taiwan
4. 4
School of Public Health, National Defense Medical Center, National Defense University, Taipei, Taiwan
5. 5
Center for Disease Control, Department of Health, Taipei, Taiwan
6. 6
Taipei City STD Control Center, Taipei, Taiwan
1. Dr K-T Chen, Department of Public Health, College of Medicine, National Cheng Kung University, No 1 University Road, Tainan, Taiwan; ktchen{at}mail.ncku.edu.tw

## Abstract

Objective: To assess the cost-effectiveness of syndromic management for the treatment of sexually transmitted diseases (STD) in comparison with the strategies currently used in STD clinics in Taiwan.

Methods: 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), aetiological diagnosis and syndromic management were compared in terms of diagnostic accuracy, treatment appropriateness, costs and effectiveness.

Results: 473 patients met the inclusion criteria and were enrolled in the study. 335 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 the detection of chlamydial, gonococcal and combined forms of infection were 100%, 40.0% and 60.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 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 the detection of syphilis were 78.8%, 18.1% and 23.2%, respectively. The average cost of implementing a correct treatment using the current approach was US$54.27 and US$30.74 for urethritis and syphilis, respectively. For the aetiological approach, the average cost of implementing a correct treatment was US$32.83 and US$21.58 for urethritis and syphilis, respectively. For the syndromic approach, the average cost for a correct treatment was US$3.86 and US$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 compared with the current and aetiological protocols for STD.

## Footnotes

• Competing interests: None declared.

• Ethics approval: This study was approved by the Ethics Committee of Taipei City STD Control Center, Taiwan.

• Contributors: C-HT coordinated the data analysis and wrote the draft of this paper. T-CL, H-LC and L-HT contributed the statistical work and wrote the methods. C-CC contributed laboratory work in this study. K-TC was the lead writer and coordinator of the manuscript and worked on content development.

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