Background Congenital syphilis imposes a significant global health and economic burden. Serious adverse events, including infant mortality and infection, occur in more than half of cases. The annual global medical cost burden exceeds $300 million. Syphilis screening and treatment, though simple, effective, and affordable, fails to reach most pregnant women. In this presentation we examine the financial sustainability of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in diverse programmatic, epidemiologic, and economic contexts.

Methods We modeled the program cost, health impact, and net cost of expanded syphilis screening and treatment in ANC, for 1,000,000 pregnancies per year over four years. We described 8 generic country scenarios by varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare.

Findings Program costs are estimated at $4,142,287 – $8,235,796 per million pregnant women. Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program yields net savings in four scenarios, and has low net costs in the other four.

Conclusions Eliminating vertical transmission of syphilis through expanded screening and treatment in ANC appears highly sustainably in economic terms for varied settings. Countries with high prevalence, low current service coverage, and high healthcare cost would be most likely to realize net savings. This analysis approach can be adapted to other conditions.