|
.gif)
|
|
Modified syndromic
management for men with urethral discharge and genital ulcers was a
valid and cost-effective approach for treatment of STDs in China.
Is syndromic
management better than the current approach for treatment of STDs in
China? Evaluation of the cost-effectiveness of syndromic management for
male STD patients.
Liu H, Jamison D, Li X, Ma E, Yin Y, Detels
R.
Sexually
Transmitted Diseases 2003;30:327-330
Summary:
Question
What is the performance of syndromic management for urethral discharge,
dysuria, and genital ulcers in men attending STD clinics in China compared
to laboratory diagnosis, and what is the cost-effectiveness compared to
current clinical procedures?
Design
This study describes a blinded comparison of the diagnostic accuracy,
treatment appropriateness, costs, and effectiveness of modified WHO
syndromic algorithms with current clinical procedures for men with
urethral discharge, dysuria, or genital ulcers attending STD clinics in
China.
Participants
Four hundred two men attending one of four STD clinics in Hefei, China,
and reporting genitourinary symptoms were evaluated. Two hundred ninety
(72%) men had genital discharge, 57 had dysuria without discharge (14%),
and 55 reported genital ulcers (14%).
Description of Tests and Diagnostic
Standard
Men with urethral discharge, dysuria, or genital ulcers were evaluated
according to current clinic practices, and using two WHO syndromic
algorithms. The algorithm for men with urethral discharge was modified to
include all men with urethral discharge or dysuria. For laboratory
diagnosis of STDs, specimens were collected and transported to the Chinese
National Center for STD Control and Prevention in Nanjing for testing for
the presence of C. trachomatis and N. gonorrhoeae in samples
from men with urethral discharge or dysuria, and for T. pallidum,
herpes simplex virus, and H. ducreyi in samples from men with
genital ulcers. Final diagnosis for treatment purposes was based on the
physicians' experience as well as the results of the local clinic
laboratory tests. Laboratories in different STD clinics used different
methods and the procedures in each laboratory were performed as usual.
Costs of the current approach included the amount paid for laboratory
tests, physical examination, and drugs. The costs of syndromic management
included expenses for physical examination, drugs, materials for health
education, and condoms. Correctly treated men were defined as those whose
conditions were correctly diagnosed and treated.
Main Outcome Measures
Diagnoses based on the syndromic algorithms were compared to the
laboratory diagnoses from the national center to determine the
sensitivity, specificity, and positive predictive value (PPV) of the
algorithms. The cost per correct treatment using the syndromic algorithm
was compared to that using current practices.
Main Results
Among 402 men with genitourinary symptoms, 227 of 290 with urethral
discharge and 13 of 57 with dysuria were positive for C. trachomatis
and/or N. gonorrhoeae. Thirteen of 53 men with confirmed genital
ulcers were positive for T. pallidum, 15 were positive for HSV, and
none had H. ducreyi. The performance of the algorithms is shown in
the table. If syndromic management, modified to include men with dysuria,
had been used to determine treatment, all men with N. gonorrhoeae, C.
trachomatis, and T. pallidum infections would have been
correctly treated. Compared to the current methods, the same number of men
with urethritis, but more men with genital ulcer, would have been
overtreated. The average costs per correct treatment using current
procedures and syndromic management were $323.48 and $3.15, respectively,
for urethritis patients, and $85.65 and $13.54, respectively, for patients
with syphilis.
Authors' Conclusions
Syndromic management, modified to include
dysuria in the urethral discharge algorithm, would have high validity and
cost-effectiveness in the treatment of men with STDs and could be easily
implemented in China. The cost per correct treatment by the current
approach, with both incorrect and overtreatment considered, was much
higher than for syndromic management.
Source of funding: National Institutes
of Health/Fogarty International Center.
For correspondence: Roger Detels,
University of California, Los Angeles, Department of Epidemiology, Box
951772, Los Angeles, CA 90095-1772. E-mail address: detels@ucla.edu
|
