Cost-Effectiveness of with Rapid-Test Etiological vs. Syndromic Diagnosis in Non-Pregnant Women with Symptoms of Cervical Infection

Abstract

Objective: To estimate the cost-effectiveness of the etiological approach with rapid tests at the site of care compared to the syndromic diagnosis in non-pregnant women with symptoms of lower genital tract infection.Materials and Methods: A decision tree was built in TreeAge® to estimate the cost-effectiveness ratio of the etiological approach with rapid tests Acon®Plate (Neisseria-Chlamydia), Acon®Duo (Neisseria-Chlamydia), and Acon®Plate (Neisseria) QuickVue® (Chlamydia) compared to syndromic diagnosis, including antibiotic treatment for the index patient and his/her sexual contact depending on the diagnosis. The perspective was that of the health system, including all direct costs. All monetary amounts were expressed in Colombian pesos of 2010. The outcome was clinical improvement. Data on the operating characteristics of the tests were taken from a cohort of 1 444 sexually active women between 14 and 49 years of age with clinical symptoms of lower genital tract infections in three hospitals in Bogota. The results of the diagnostic alternatives were compared to the gold standard (PCR). Data on treatment effectiveness were extracted from the literature. The incremental cost-effectiveness ratio was calculated. Univariate and probabilistic sensitivity analyses were performed.Results: The most effective and expensive alternative was Acon®Plate (Neisseria) QuickVue®(Chlamydia), followed by Acon®Duo (Neisseria-Chlamydia) and by the syndromic approach. Acon®Plate (Neisseria-Chlamydia) was a dominated strategy. The incremental cost-effectiveness ratio of Acon®Plate (Neisseria) QuickVue®(Chlamydia) was $2.782.690, and that of Acon®Duo (Neisseria-Chlamydia) was $ 597.886. The probabilistic sensitivity analysis confirmed the order of the alternatives. Results were sensitive to the operating characteristics of the tests, the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae, and to the cost of treatment.Conclusion: If the willingness to pay (WTP) for an additional case of clinical improvement is greater than $2.782.690 (COP), Acon®Plate (Neisseria gonorrhoeae) in combination with QuickVue® (Chlamydia trachomatis) would be the best alternative in terms of cost-effectiveness. For a WTO between $597.886 (COP) and $2.782.690 (COP), Acon®Duo (Chlamydia trachomatis and Neisseria gonorrhoeae) would be cost-effective. Finally, if the WTP is lower than $597 886 (COP), the syndromic approach would be cost-effective.