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1.
Value Health Reg Issues ; 23: 61-69, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32841902

RESUMO

OBJECTIVES: Severe consequences of mother-to-child transmission of syphilis and high increasing incidence of congenital syphilis remains an important public health problem in Brazil. Our objective was to assess the cost-effectiveness of a rapid point-of-care test (RT) and treatment of positive mothers immediately compared with a laboratory-based standard test (ST) with treatment at next follow-up visit. METHODS: A decision analytic model was developed to estimate the incremental cost-effectiveness ratio (ICER) between antenatal syphilis screening strategies. The model was built with lifetime horizon from Brazilian health system perspective using 3% and 5% discount rates. A hypothetical cohort of pregnant women at reproductive age were used in the model. Health outcomes: low birth weight, stillbirths, neonatal deaths and congenital syphilis were estimated in disability-adjusted life-years (DALYs) lost. Microcosting study and secondary data provided parameters of direct medical costs. Probabilistic sensitivity analysis was undertaken. RESULTS: For base case, the mean cost per pregnant woman screened was $2.63 (RT) and $2.48 (ST), respectively. Maternal syphilis was associated with a loss of 0.0043 DALYs (RT) and 0.0048 DALYs (ST) per mother screened. Expected value of incremental cost per DALY averted was $298.08. After 10 000 probabilistic sensitivity analysis model runs, incremental cost and health benefits were $0.15 (95% credible interval -1.56 to 1.92) and 0.00042 DALYs (95% credible interval -0.0036 to 0.0044), respectively, with a mean ICER of $357.44 per DALY. Screening with RT has a 58% chance of being the optimal strategy at a threshold of $3,200 per DALY. CONCLUSIONS: In Brazil, antenatal screening with syphilis RT and immediate treatment is likely to be cost-effective compared with standard screening and must be prioritized in local settings.


Assuntos
Técnicas de Laboratório Clínico/economia , Análise Custo-Benefício/normas , Testes Imediatos/economia , Diagnóstico Pré-Natal/economia , Sífilis Congênita/diagnóstico , Adolescente , Adulto , Brasil , Criança , Técnicas de Laboratório Clínico/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Pessoa de Meia-Idade , Testes Imediatos/estatística & dados numéricos , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricos , Sífilis Congênita/prevenção & controle , Sífilis Congênita/transmissão
2.
Artigo em Inglês | MEDLINE | ID: mdl-31555457

RESUMO

Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.


Assuntos
Diabetes Mellitus/diagnóstico , Doenças não Transmissíveis/epidemiologia , Testes Imediatos/normas , Insuficiência Renal Crônica/diagnóstico , Adulto , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/estatística & dados numéricos , Efeitos Psicossociais da Doença , Diabetes Mellitus/epidemiologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/prevenção & controle , Obesidade/diagnóstico , Obesidade/epidemiologia , Testes Imediatos/economia , Controle de Qualidade , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , População Rural/estatística & dados numéricos
3.
PLoS One ; 11(3): e0149568, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26949941

RESUMO

Studies have addressed cost-effectiveness of syphilis testing of pregnant women in high-prevalence settings. This study compares costs of rapid syphilis testing (RST) with laboratory-based rapid plasma reagin (RPR) tests in low-prevalence settings in Peru. The RST was introduced in a tertiary-level maternity hospital and in the Ventanilla Network of primary health centers, where syphilis prevalence is approximately 1%. The costs per woman tested and treated with RST at the hospital were $2.70 and $369 respectively compared with $3.60 and $740 for RPR. For the Ventanilla Network the costs per woman tested and treated with RST were $3.19 and $295 respectively compared with $5.55 and $1454 for RPR. The cost per DALY averted using RST was $46 vs. $109 for RPR. RST showed lower costs compared to the WHO standard costs per DALY ($64). Findings suggest syphilis screening with RST is cost-effective in low-prevalence settings.


Assuntos
Testes Imediatos/economia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Sífilis/diagnóstico , Sífilis/epidemiologia , Aborto Espontâneo , Análise Custo-Benefício , Parto Obstétrico , Feminino , Humanos , Mães , Peru/epidemiologia , Gravidez , Prevalência , Fatores de Tempo
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