May 2002

Estimating the Cost and Effectiveness of Different STI Management Strategies for
Sex Workers in Madagascar

Conclusion

The study indicates that a modeled cost-effectiveness analysis can provide useful and sometimes unexpected findings about the use of various approaches to the management of STIs, which in turn has implications for HIV prevention. In this case, an affordable strategy for screening and treatment of a particularly vulnerable group was developed with information on cost-effectiveness and with involvement of the intended audience.

The findings also illustrate that a tension exists between cost and effectiveness: More effective methods of diagnosing cases of STI are more costly. The use of laboratory tests would be the most effective way of diagnosing STIs in sex workers, but their high costs are often not affordable. Instead, other less costly but less effective options were considered. The study found that the most cost-effective approach to the management of STIs in most cases is to make treatment decisions based on a combination of syndromic management and risk assessment, rather than to rely on any but the most simple laboratory tests. For a disease such as syphilis, for which a cheap and relatively simple laboratory test is available, use of that test represents the most cost-effective way of managing infections.

The findings on costs and effectiveness differed for each STI, indicating that disaggregated analysis is necessary in studies of cost-effectiveness of STI management.

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03 Jan 2009