Cost-effectiveness of syphilis intervention strategies among men who have sex with men in China: A 10-year Markov modelling study.

OBJECTIVES

Syphilis has re-emerged as a major public health challenge in China, particularly among men who have sex with men (MSM). Although global evidence supports screening and behavioral interventions, the cost-effectiveness of integrated strategies in the MSM population in China remains underexplored.

STUDY

DESIGN

A cost-effectiveness analytical study based the hybrid decision tree-Markov model.

METHODS

A decision tree-Markov model was developed to evaluate the costs, health impact, and cost-effectiveness of twelve syphilis intervention scenarios (S1-S12) among a hypothetical cohort of 100,000 Chinese MSM over 10 years. Scenarios varied by screening frequency and behavioral components. Model parameters were derived from Chinese CDC reports, hospital data, and literature. Costs and quality-adjusted life years (QALYs) were estimated from the health provider's perspective, with incremental cost-effectiveness ratios (ICERs) compared to a willingness-to-pay threshold of three times the Chinese GDP per capita. Probabilistic and one-way sensitivity analyses were conducted to assess the robustness.

RESULTS

Quarterly screening (S9) is the most cost-effective strategy for controlling syphilis among Chinese MSM, offering substantial health benefits and cost savings, with a 99.6 % probability of cost-effectiveness at a willingness-to-pay threshold of $41,601 per QALY. Quarterly screening demonstrated optimal effectiveness, reducing syphilis infections by 20.6 %-21.5 % (22,723-23,666 cases prevented) while increasing the susceptible population by 18.5 %-22.5 % compared to status quo (S1). Compared with quarterly screening (S9), quarterly screening with condoms (S10) increased the ICER to $653,697.7 per QALY, while with comprehensive intervention (S12) increased to $1,621,708.9 per QALY.

CONCLUSIONS

Quarterly syphilis screening represents the most cost-effective strategy for Chinese MSM. While behavioral interventions provide additional benefits, their cost-effectiveness diminishes with more intensive intervention. These findings underscore the importance of prioritizing expanded screening access in Chinese MSM population, with phased integration of behavioral interventions based on local resource availability.