Cost-effectiveness of on-site antenatal screening to prevent congenital syphilis in rural eastern Cape Province, Republic of South Africa

Sex Transm Dis. 2007 Jul;34(7 Suppl):S61-6. doi: 10.1097/01.olq.0000258314.20752.5f.


Objectives: On-site screening and same-day treatment of maternal syphilis in underresourced settings can avert greater numbers of congenital syphilis cases, but health outcomes and associated costs must be evaluated jointly.

Methods: We used decision analysis to estimate the incremental cost-effectiveness of two on-site antenatal syphilis screening strategies to avert congenital infections-qualitative RPR (on-site RPR) and treponemal immunochromatographic strip assay (on-site ICS)-compared to the current practice (off-site RPR/TPHA).

Findings: With antenatal active syphilis prevalence of 6.3%, the incremental cost-effectiveness of on-site ICS in averting congenital infections was estimated to be USD104, averting 82% of cases expected in absence of a program. The incremental cost-effectiveness of off-site RPR/TPHA was USD82 but would avert only 55% of congenital syphilis cases. On-site RPR was dominated by the other screening strategies.

Conclusions: In settings of high maternal syphilis prevalence, on-site antenatal screening with ICS is a cost-effective approach to reduce the incidence of congenital syphilis.

Publication types

  • Evaluation Study

MeSH terms

  • Chromatography / methods
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • Humans
  • Immunoassay
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control
  • Point-of-Care Systems / economics*
  • Point-of-Care Systems / standards
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Complications, Infectious / blood
  • Pregnancy Complications, Infectious / diagnosis*
  • Pregnancy Complications, Infectious / epidemiology
  • Pregnancy Complications, Infectious / etiology
  • Pregnancy Complications, Infectious / prevention & control
  • Prenatal Diagnosis / economics*
  • Prenatal Diagnosis / standards
  • Reagins / blood
  • Rural Health Services
  • Sensitivity and Specificity
  • South Africa / epidemiology
  • Syphilis / blood
  • Syphilis / diagnosis*
  • Syphilis / drug therapy
  • Syphilis / transmission
  • Syphilis Serodiagnosis / economics
  • Syphilis Serodiagnosis / standards
  • Syphilis, Congenital / prevention & control*
  • Treponema / immunology


  • Reagins