Cost-effectiveness of an opt-out emergency department screening program for syphilis in North Queensland’s Aboriginal and Torres Strait Islander population

Background This study aimed to evaluate the cost-effectiveness of an emergency department (ED) syphilis screening program for the Aboriginal and Torres Strait Islander population (aged 15–40 years) presenting to a regional Australian ED, compared with no screening program. Methods A decision tree model was developed using clinical data from a previous audit and outcome probabilities from the literature. We included direct financial costs from a healthcare provider perspective and outcomes measured in quality-adjusted life years (QALYs) gained, over a 40-year time horizon. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and hospital costs classified according to the Australian refined diagnosis-related groups. Both costs and outcomes were discounted by 5% per year. An incremental cost-effectiveness ratio was estimated and subjected to sensitivity analyses. Results With a background syphilis prevalence of 0.68%, screening Aboriginal and Torres Strait Islander peoples, aged 15–40 years, presenting to a regional ED compared with no screening was A$134,802 per QALY gained. The program becomes cost-effective (using a willingness-to-pay threshold of A$50,000) at a syphilis prevalence of 1.55%. The incremental cost-effectiveness ratio was most sensitive to probabilities of syphilis progression, syphilis prevalence and specificity of the initial screening test. Conclusion The ED syphilis screening program for Aboriginal and Torres Strait Islander peoples was not cost-effective with the current background rate of syphilis. However, similar screening programs in settings with a higher burden of syphilis may be cost-effective, and further refining the target population based on additional risk factors could help reduce costs.

Sexual Health

Sexual Health

23

1449-8987

N/A

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