A Cost-Effectiveness Model of Three Protocols for the Diagnosis and Treatment of Sexually Transmitted Diseases in South Africa

Rebecca Woods, University of California at Berkeley
Nuriye Hodoglugil, University of California at Berkeley
Julia Walsh, University of California at Berkeley

This paper evaluates the cost-effectiveness of gold standard, mass treatment, and syndromic management for Gonorrheal and Chlamydial care among South African women. Using a hypothetical cohort of 20 million women, we model the effects of each protocol on cost per STD cured and cost of overtreatment, develop decision-tree modeling techniques for each strategy using probability data derived from the literature, and run Monte Carlo simulations using probability ranges from our sensitivity analyses. We find mass treatment most cost-effective with baseline costs of US$130 per case cured (range under sensitivity analyses of US$104-198), followed by syndromic management at US$315 (US$102-508) and gold standard care at US$398 (US$115-644). Overtreatment runs in the same order with mass treatment. Monte Carlo simulations suggest that, while lower costs per case are more likely in the syndromic management and even gold standard case than mass treatment, their probability distributions appear skewed leftwards.