Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are sexually transmitted infections (STIs) associated with adverse outcomes, including low birth weight (LBW). Most countries don’t test pregnant women and use syndromic management, which misses asymptomatic infections. This study used a decision model to assess the cost-effectiveness of testing pregnant women for CT and NG using the GeneXpert compared to syndromic management in Botswana.
Methods Using costs and implementation data from a previous study and outcome data from the literature, we modelled the short-term incremental costs and neonatal outcomes of both scenarios from a health services prospective. For the base case, we assumed CT and NG prevalence rates were 7.8% and 1.3%, and the probabilities of LBW associated with maternal CT was 5% and NG was 58%. Probabilities of death and disability weights came from the World Health Organization.
Results Offering CT and NG testing to approximately 50,000 antenatal patients in Botswana had a one-year cost of $925,804 more than syndromic management. Testing was associated with 4,322 more cured maternal infections, and 612 more cases of LBW infants averted, which is $1,513 per LBW infant averted and $320 per disability adjusted life year (DALY) averted. The incremental cost-effectiveness ratios were most sensitive to the assumed prevalence of CT and NG, probability of LBW, disability weight, treatment uptake, and capital costs.
Conclusion Testing for CT and NG infections is more costly than syndromic management. However, testing is estimated to prevent LBW infants and DALYs. CT/NG testing scale-up is cost-effective if policy-makers’ willingness to pay is informed by the WHO 1 Gross Domestic Product/capita threshold ($7,596/DALY averted in Botswana). While the costs of testing may be high for countries with constrained budgets in Southern Africa, reductions in antenatal STIs may help address the important global goal of preventing LBW.
Disclosure No significant relationships.
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