Sexual health · 2026
Cost-effectiveness of an opt-out emergency department screening program for syphilis in North Queensland's Aboriginal and Torres Strait Islander population.
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Moncrieff Leah, Heal Clare, Hall Leanne, Lawton Luke, Ong Jason J
Аннотация
BACKGROUND: This study aimed to evaluate the cost-effectiveness of an emergency department (ED) syphilis screening program for the Aboriginal and Torres Strait Islander population (aged 15-40 years) presenting to a regional Australian ED, compared with no screening program.
METHODS: A decision tree model was developed using clinical data from a previous audit and outcome probabilities from the literature. We included direct financial costs from a healthcare provider perspective and outcomes measured in quality-adjusted life years (QALYs) gained, over a 40-year time horizon. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and hospital costs classified according to the Australian refined diagnosis-related groups. Both costs and outcomes were discounted by 5% per year. An incremental cost-effectiveness ratio was estimated and subjected to sensitivity analyses.
RESULTS: With a background syphilis prevalence of 0.68%, screening Aboriginal and Torres Strait Islander peoples, aged 15-40 years, presenting to a regional ED compared with no screening was A$134,802 per QALY gained. The program becomes cost-effective (using a willingness-to-pay threshold of A$50,000) at a syphilis prevalence of 1.55%. The incremental cost-effectiveness ratio was most sensitive to probabilities of syphilis progression, syphilis prevalence and specificity of the initial screening test.
CONCLUSION: The ED syphilis screening program for Aboriginal and Torres Strait Islander peoples was not cost-effective with the current background rate of syphilis. However, similar screening programs in settings with a higher burden of syphilis may be cost-effective, and further refining the target population based on additional risk factors could help reduce costs.
METHODS: A decision tree model was developed using clinical data from a previous audit and outcome probabilities from the literature. We included direct financial costs from a healthcare provider perspective and outcomes measured in quality-adjusted life years (QALYs) gained, over a 40-year time horizon. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and hospital costs classified according to the Australian refined diagnosis-related groups. Both costs and outcomes were discounted by 5% per year. An incremental cost-effectiveness ratio was estimated and subjected to sensitivity analyses.
RESULTS: With a background syphilis prevalence of 0.68%, screening Aboriginal and Torres Strait Islander peoples, aged 15-40 years, presenting to a regional ED compared with no screening was A$134,802 per QALY gained. The program becomes cost-effective (using a willingness-to-pay threshold of A$50,000) at a syphilis prevalence of 1.55%. The incremental cost-effectiveness ratio was most sensitive to probabilities of syphilis progression, syphilis prevalence and specificity of the initial screening test.
CONCLUSION: The ED syphilis screening program for Aboriginal and Torres Strait Islander peoples was not cost-effective with the current background rate of syphilis. However, similar screening programs in settings with a higher burden of syphilis may be cost-effective, and further refining the target population based on additional risk factors could help reduce costs.