Start | Browse by Day | Author Index | Browse Handouts

C6.1 Exploring the Cost-Effectiveness of Syphilis Point-of-Care (POC) Tests for Screening Men Who Have Sex with Men (MSM) in Nonmedical Settings

Wednesday, March 14, 2012: 10:30 AM
Greenway Ballroom H/I/J
Kwame Owusu-Edusei Jr., PhD1, Robert E. Johnson, MD, MPH2, Karen W. Hoover, MD, MPH3, Arnold Castro, PhD3 and Thomas A. Peterman, MD, MSc4, 1Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, 2Division of STD Prevention, The Centers for Disease Control and Prevention, Atlanta, GA, 3Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 4Epidemiology and Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA

     

Background:  Rapid tests offer the advantage of providing immediate test results to improve the effectiveness of follow-ups.

Objectives:  We compare syphilis rapid tests with the standard (i.e., RPR/TP-PA) for screening MSM in an outreach program in the US.

Methods: We estimated the number of “successful referrals” for treatment (i.e., identified infected individuals who eventually present for treatment) and the total costs for three screening strategies: treponemal and nontreponemal dual antigen POC (Dual-POC, $11), Treponemal POC (TrepOnly-POC, $10) and the RPR($7)/TP-PA($22) (includes, test kits and labor cost). Treatment cost was not included. Assumptions: perfect performance for RPR/TP-PA (i.e., 100% sensitivity and specificity); individuals have perfect memory of their syphilis history; for the Dual-POC, nontrep-trep+ were retested with EIA if they had no history (conclude previous infection otherwise); if nontrep+trep+ or only trep+ and have had syphilis before, draw blood for quantitative RPR. Probabilities of presenting for treatment, no test results, 80%; if initial results provided (i.e., nontrep+/-trep+ or only trep+), 90% for repeat infections and 95% for new infections.

Results:  For 10,000 individuals (1% infected and 10% previously infected), we estimated 10,000 blood-draws for RPR/TP-PA; 10,000 fingersticks for both POCs; 960 blood-draws for TrepOnly-POC; 295 blood-draws for Dual-POC. The final results: TrepOnly-POC – successful referrals 91, total cost $114,000, cost-effectiveness ratio (CE) $1,253; Dual-POC – successful referrals 91, total cost $116,000, CE $1,274; RPR/TP-PA – successful referrals 80, total cost $164,000, CE $2,050. The TrepOnly-POC strategy required drawing blood unnecessarily from a substantially higher number of individuals than the Dual-POC strategy (950 vs. 285). The Dual-POC was more cost-effective than the TrepOnly-POC ($1,274 vs $1,363) when the costs were the same ($11).

Conclusions:  The Dual-POC test offers the additional advantage of eliminating unnecessary follow-ups for nontrep-trep+ individuals with previous infections.

Implications for Programs, Policy, and Research:  Excluding information provided by the nontreponemal tests may result in unnecessary blood-draws/follow-ups.

See more of: Out of the Closet: Clinical Care for Your MSM Population
See more of: Oral and Poster
Previous Abstract | Next Abstract >>