Repeat screening for syphilis in the third trimester of pregnancy

A cost-effectiveness analysis

Alyssa R. Hersh, Christina J. Megli, Aaron Caughey

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: To estimate the cost-effectiveness of screening all women during the first and third trimesters compared with screening just once during pregnancy. METHODS: We used a theoretical cohort of 3.9 million women in the United States to model syphilis screening approaches in pregnancy, particularly comparing onetime screening with repeat third-trimester screening. Outcomes of syphilis infection included in the model were congenital syphilis, intrauterine fetal demise, neonatal death, and total quality-adjusted life-years (QALYs). Probabilities, utilities, and costs were obtained from the literature, and a cost-effectiveness threshold was set at $100,000 per QALY. A societal perspective was assumed. RESULTS: Our model demonstrated that repeat screening in the third trimester for syphilis in pregnancy will result in fewer maternal and neonatal adverse outcomes and higher QALYs when compared with screening once in the first trimester. Specifically, we demonstrated that repeat screening results in 41 fewer neonates with evidence of congenital syphilis, 73 fewer cases of intrauterine fetal demise, 27 fewer neonatal and infant deaths, in addition to a cost savings of $52 million and 4,000 additional QALYs. CONCLUSION: Using our baseline assumptions, our data support that in pregnancy, repeat screening for syphilis is superior to single screening during the first trimester and is both cost-effective and results in improvement in maternal and neonatal outcomes. When screening policies are being created for pregnant women, the cost-effectiveness of repeat screening for syphilis should be considered.

Original languageEnglish (US)
Pages (from-to)699-707
Number of pages9
JournalObstetrics and Gynecology
Volume132
Issue number3
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Third Pregnancy Trimester
Syphilis
Quality-Adjusted Life Years
Cost-Benefit Analysis
First Pregnancy Trimester
Congenital Syphilis
Pregnancy
Fetal Death
Mothers
Costs and Cost Analysis
Cost Savings
Pregnant Women
Newborn Infant
Infection
Perinatal Death

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Repeat screening for syphilis in the third trimester of pregnancy : A cost-effectiveness analysis. / Hersh, Alyssa R.; Megli, Christina J.; Caughey, Aaron.

In: Obstetrics and Gynecology, Vol. 132, No. 3, 01.01.2018, p. 699-707.

Research output: Contribution to journalArticle

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