Universal 3rd-Trimester Syphilis Rescreening Not Cost-Effective
(HealthDay News) — Universal third-trimester syphilis rescreening is not cost-effective given the national average seroconversion rate, according to a study published in the September issue of Obstetrics & Gynecology.
Catherine M. Albright, MD, from Brown University in Providence, RI, and colleagues estimated the cost to prevent one case of congenital syphilis or fetal or neonatal death and the number needed to rescreen to prevent one adverse outcome. They used a decision model comparing universal third-trimester syphilis rescreening with no rescreening in women who screened negative in the first trimester. The assumed base case incidence of seroconversion was 0.012%. A strategy was considered cost-effective if it cost <$285,000 to prevent one case of congenital syphilis.
The researchers found that universal third-trimester rescreening would cost an additional $419,842 for each case of congenital syphilis prevented and $3,621,144 and $6,052,534, respectively, for each fetal and neonatal death prevented. Preventing 60 cases of congenital syphilis along with seven fetal and four neonatal deaths would require rescreening 4,000,000 women, whereas preventing one case of congenital syphilis would require screening 65,790 women. Third-trimester rescreening would be cost-effective with a seroconversion incidence of 0.017%.
"Universal third-trimester syphilis rescreening requires a large number of women be rescreened at a high health care cost to prevent one adverse outcome from maternal syphilis," the authors write. "Seroconversion incidence must be 19-fold higher than the national average of primary and secondary syphilis in women for universal third-trimester rescreening to be cost-effective."