Costos de Sifilis No Tratada

7/29/2019 Costos de Sifilis No Tratada

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RATES OF ADVERSE OUTCOMES OFUNTREATED MATERNAL SYPHILIS

ORGANIZACIN MUNDIAL DE LA

SALUD


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OUTCOME OFPREGNANCY

Harman Ingraham Schulz etal.

Hira et. al. WatsonJones etal.

GlobalBurden ofSTI.

Stillbirth ormiscarriage

17% 22% 30 40 % 22% 25% 20%

Perinataldeath

23% 12% 10 20% No data No data 15%

InfectedInfant

21% 33% 10 20% 2% No data 20%

Prematurity

or low birthweight

No data No data Not

studied

33% 25% 20%

Any adverseoutcome

61% 67% 50 80% 57% 49% 75%

STUDY


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STUDIES OF MATERNAL SYPHILISSEROPREVALENCE 1997 2003


SALUD


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Proportion ofseropositivewomen with:

Conservativemodel

Mid range model Less conservativemodel

a. Untreatedsypjilis

0.95 1.0 1.0

b. High serologicaltitre (> 1:8)

0.73 - -

c. Adversepregnancyoutcome due to

syphilis

0.49 0.65 0.75

Global annualnumbre ofcongenital syphiliscases

713 600 1 365 000 1 575 000


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ESTIMATES OF ANNUAL INCIDENCEOF CONGENITAL SYPHILIS


SALUD


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WHO region Country No. Ofstudies

No. Of women tested Seroprevalence amongpregnant women

BENIN 28 18 790 1.68

BURKINA FASO 3 17 322 0.21

CAMEROON 10 6 306 2.81

COTE DIVOIRE 1 1201 1.30

ETHIOPIA 3 3582 2.74

GHANA 31 28 082 0.40

KENYA 4 14 694 2.29

MALAWI 42 32 752 3.67

MALI 1 549 2.00

NIGERIA 13 68 930 2.35

SENEGAL 21 68 930 2.35

SOUTH FRICA 1 271 8.40

UGANDA 2 2379 6.49

ZINBABWE 2 6967 0.76

FRI

CA


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WHO region Country No. Of studies No. Of womentested

Seroprevalenceamong pregnant

women

ARGENTINA 1 1056 1.61

BRASIL 4 4203 2.15

GUATEMALA 1 1170 0.09

HAIT 16 7710 5.75

BNAGLADESH 2 508 2.57

INDIA 1 600 1.00

INDONESIA 1 395 0.80

AZERBAIJAN 1 407 1.70

FINLAND 1 59 112 1.50

A

MRICA

S

SOUTEAST ASIA

EUROPE


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WHO region Country No. Of studies No. Of womentested

Seroprevalenceamong pregnant

women

SOMALIA 4 1538 0.91

SUDAN 1 800 1.50

CHINA 6 126 032 0.44

MALAYSIA 1 1070 0.30

KOREA R. 4 7126 0.11

NEW GUINEA 1 5385 7.10

VANUATU 7 1611 2.42

WESTERNSAMOA

1 441 0.40

TOTAL 215 431 452

EASTERN

MEDITERRANEAN

WESTERNPACIFIC


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COSTS (IN U$ 2001 PRICES) OF SCRENING

AND TREATMENT ANDO COST SAVINGSACHIEVED IN FOUR COST . EFFECTIVENESS

STUDIES IN AFRICA 1986 2001

ORGANIZACIN MUNDIAL DE LASALUD


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TYPE OF COST

STUDY

Cost per womanscreened 0.93 1.96 1.24 1.44

Cost per womantreated

22.11 34.26 40.32 20.05

Cost per persontreated

11.93 21.82 26.27 14.54

Cos per congenitalsyphilis caseaverted

158 86 177

Cost per DALYsaved:

-Original analysis

by author.

-Costo obtainedwith the applicationof the TerrisPrestholt model tothe original data

3.97

11.28

9.84

17.48

9.57

18.73

N/A

10.56

Hira et al.Jenniskens et

al.Fonck et al.

Terris Prestholtet al.


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TEST FOR ADULT ANDCONGENITAL SYPHILIS


SALUD


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Dark fieldmicroscopy

Antigendetection

(DFA TP)

DNAdetection

(PCR and RTPCR)

NON TREPONEMALTEST

TREPONEMAL TEST

Sensitivity 74 86% 73 100% 91% 86 100% 78 100% 84 100% 82 100% 85 100% 70 100%

Specificity 85 97% 89 100% 99% 93 98% 98 100% 94 98% 97 100% 98 100% 94 100%

Ease ofuse

Easy Moderate Complex Easy Easy Easy moderate Complex Complex

Level ofuse

Examination room, onsite

laboratory

Intermediateor referrallaboratory

Referrallaboratory

Examinationroom, on sitelaboratory



Intermediateor referrallaboratory

Referrallaboratory

Referrallaboratory

Equipment

Lightmicroscope with dark fieldcondenser

Fluorescencemicroscope

Microfuge,thermal cycler,incubator,microwell platereader

Rotator Lightmicroscope

None Incubator,microwellplatewasher andreader

Incubator,microwellplatewasher andreader

Fluorescencemicroscope

Training Extensive Moderate Extensive Minimal Minimal Minimal Moderate Extensive Extensive

Averagecost

U$ 0.40 U$ 3 U$ 14 U$ 0.50 U$ 0.50 U$ 0.55

3.0

U$ 3 U$ 3 U$ 3

Comments

Specificitymay becompromised bypresence ofdebris orendogenoustreponemes

RT PACR is100x moresensitive thanDNA PCR, butneither candistinguishbetween T.pallidum and T.pertenue

Most RPRreagentsrequirerefrigeration

Reagentsrequirerefrigeration

Most testscan be storedat roomtemperaturefor 9 18months

Allows highthroughputscreening

Confirmatorytest; does notdistinguishbetween pasttreated andactiveinfection

Confirmatorytest; does notdistinguishbetween pasttreated andactiveinfection

FOR PATIENTS PRESENTING WITH ANULCER OR OTHER LESION FOR SCREENING

RPR VDRL RAPID TEST EIATPHA /TPPA

FTA - ABS


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TOOLS FOR THE PREVENTION ANDCONTROL OF MATERNAL AND

CONGENITAL SYPHILIS IN DIFFERENT

SETTINGS

ORGANIZACIN MUNDIAL DE LASALUD


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DIAGNOSIS/SCREENING TEST SURVEILLANCE

LOCAL REGIONALLABORATORY

REFERENCELABORATORY

SENTINELSITES

REFERENCELABORATORY

MATERNALSYPHILIS

SYMPTOMATIC None Dark fieldmicroscopy, DFATP

Molecular tests suchas PRC

Dark fieldmicroscopy,DFA TP

Molecular tests

ASYMPTOMATIC RPRRapidtreponemal test

RPR/VDRL EIARapid treponemaltest

RPR/VDRL EIATPHA/TPPA

FTA ABSInmunoblotting

RPR/VDRL EIARapidtreponemal test

EIA

TPHA/TPPA

FTA ABS

CONGENITAL

SYPHILIS

SYMPTOMATIC None Dark fieldmicroscopy, DFATP

Molecular tests suchas PRC

Dark fieldmicroscopy,DFA TP

Molecular tests

ASYMPTOMATIC None RPR/VDRLIgM antibodydetection by EIA

RPR/VDRL

IgM antibodydetection by EIA

RPR/VDRL EIARapidtreponemal test

IgM antibodydetection by EIA


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Costos de Sifilis No Tratada

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