Romoen, Maria (Faculty of Medicine) Sundby, Johanne (Faculty of Medicine) Hjortdahl, Per (Faculty of Medicine) Hussein, Fatrima (Ministry of Health) Steen, Tore W. (Ministry of Health) Velauthapillai, Manonmany (Ministry of Health) Kristiansen, Ivar Sønbø () (Institute of Health Management and Health Economics)
Abstract
Objectives: Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity – particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. Methods: A decision analytic model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon 1) a study of pregnant women in Botswana, 2) literature reviews and 3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Results: Azithromycin was less costly and more effective than was erythromycin. Compared to syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1 500 to 3 500 in a population of 100 000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Conclusions: Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does – and at acceptable costs – especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people’s health and even reduce health care budgets.
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Publisher Info
Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number
2007:10.
Length: 103 pages Date of creation: 03 Jun 2009 Date of revision: Handle: RePEc:hhs:oslohe:2007_010
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