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Carla Castillo-Laborde
Universidad del Desarrollo
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6004-5882
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BACKGROUND: Syphilis, together with other sexually transmitted infections, remains a global public health problem that is far from being controlled. People deprived of liberty are one of the vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence of affordable alternatives that would allow switching to active case-finding strategies. Our objective was to develop a mathematical modelling framework for cost-effectiveness evaluation, from a health system perspective, of different approaches using rapid tests for the detection of syphilis in inmates' populations and to explore the results based on a Chilean male prison population.
Methods: A compartmental model was developed to characterize the transmission dynamics of syphilis inside a prison with the ongoing strategy (passive case detection, with VRDL + FTA-ABS), considering the entrance and exit of inmates over a 40 year period. The model allows simulation of the implementation of a reverse algorithm for the current situation (rapid test + VDRL), different screening strategies (entry point, massive periodically; both with rapid test + VDRL) and treatment of detected cases. The parameters for the exploratory exercise were obtained from systematic searches of indexed and grey literature and field work (EQ-5D questionnaire application and key actors interviews). Probabilistic sensitivity analysis was conducted to account for uncertainty in relevant parameters.
RESULTS: The proposed framework allows the evaluation of different detection strategies. In this study, all the strategies were cost-effective in the baseline scenario when considering an ICER threshold of 1 Chilean GDP per capita (US$15,000). The strategies most likely to be cost-effective (over 80% probability) were: current situation with reverse algorithm, entry point screening and mass screening every two years; the latter was the most effective, achieving the lowest prevalence (0.7% and 1.7% over the period versus the 3% prevalence in the current situation).
CONCLUSIONS: Mathematical modelling that considers the performance of different test and detection strategies could be a useful tool for decision making. The exploratory results show the efficiency of adopting both the use of the rapid tests and performing active case detection to significantly reduce the burden of syphilis in Chilean prisons in the near future.
Keywords
Syphilis, Modelling, Screening, Rapid Test, Cost-effectiveness
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Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- CERAsyphilisprison.pdf
Appendix 1. Mathematical models of the syphilis dynamics, costs, and health outcomes under different intervention strategies. Appendix 2. Tables of parameters: Exploratory exercise in a Chilean male prison.
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CURRENT STATUS: Published
View the published article at Cost Effectiveness and Resource Allocation.
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On 30 Dec, 2020
Editorial decision: Accept
On 30 Dec, 2020
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On 30 Dec, 2020
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On 30 Dec, 2020
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Posted 27 Dec, 2020
Editor assigned
On 27 Dec, 2020
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On 27 Dec, 2020
Editor invited
On 27 Dec, 2020
This version was not preprinted
No comments provided
Editorial decision: Minor Revision
On 03 Dec, 2020
Editor assigned
On 14 Nov, 2020
Submission checks complete
On 14 Nov, 2020
Editor invited
On 14 Nov, 2020
Version 2
Posted 04 Sep, 2020
No comments provided
Review #2 received
Received 16 Oct, 2020
Editorial decision: Minor Revision
On 16 Oct, 2020
Reviewer #3 agreed
On 13 Oct, 2020
Reviewer #2 agreed
On 12 Oct, 2020
Review #1 received
Received 27 Sep, 2020
Reviewer #1 agreed
On 13 Sep, 2020
Editor assigned
On 03 Sep, 2020
Reviewers invited
Invitations sent on 03 Sep, 2020
Submission checks complete
On 02 Sep, 2020
Editor invited
On 02 Sep, 2020
No comments provided
Editorial decision: Revise before peer review
On 11 Aug, 2020
First submitted
On 05 Aug, 2020
Editor assigned
On 05 Aug, 2020
Submission checks complete
On 04 Aug, 2020
Editor invited
On 04 Aug, 2020
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Subject Areas
Infectious Diseases
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Cost Effectiveness and Resource Allocation.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Carla Castillo-Laborde
Universidad del Desarrollo
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6004-5882
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Cost Effectiveness and Resource Allocation.
No community comments so far
Editor assigned
On 30 Dec, 2020
Editorial decision: Accept
On 30 Dec, 2020
Submission checks complete
On 30 Dec, 2020
Editor invited
On 30 Dec, 2020
Version (no preprint)
Posted 27 Dec, 2020
Editor assigned
On 27 Dec, 2020
Submission checks complete
On 27 Dec, 2020
Editor invited
On 27 Dec, 2020
This version was not preprinted
No comments provided
Editorial decision: Minor Revision
On 03 Dec, 2020
Editor assigned
On 14 Nov, 2020
Submission checks complete
On 14 Nov, 2020
Editor invited
On 14 Nov, 2020
Version 2
Posted 04 Sep, 2020
No comments provided
Review #2 received
Received 16 Oct, 2020
Editorial decision: Minor Revision
On 16 Oct, 2020
Reviewer #3 agreed
On 13 Oct, 2020
Reviewer #2 agreed
On 12 Oct, 2020
Review #1 received
Received 27 Sep, 2020
Reviewer #1 agreed
On 13 Sep, 2020
Editor assigned
On 03 Sep, 2020
Reviewers invited
Invitations sent on 03 Sep, 2020
Submission checks complete
On 02 Sep, 2020
Editor invited
On 02 Sep, 2020
No comments provided
Editorial decision: Revise before peer review
On 11 Aug, 2020
First submitted
On 05 Aug, 2020
Editor assigned
On 05 Aug, 2020
Submission checks complete
On 04 Aug, 2020
Editor invited
On 04 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Cost Effectiveness and Resource Allocation.
BACKGROUND: Syphilis, together with other sexually transmitted infections, remains a global public health problem that is far from being controlled. People deprived of liberty are one of the vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence of affordable alternatives that would allow switching to active case-finding strategies. Our objective was to develop a mathematical modelling framework for cost-effectiveness evaluation, from a health system perspective, of different approaches using rapid tests for the detection of syphilis in inmates' populations and to explore the results based on a Chilean male prison population.
Methods: A compartmental model was developed to characterize the transmission dynamics of syphilis inside a prison with the ongoing strategy (passive case detection, with VRDL + FTA-ABS), considering the entrance and exit of inmates over a 40 year period. The model allows simulation of the implementation of a reverse algorithm for the current situation (rapid test + VDRL), different screening strategies (entry point, massive periodically; both with rapid test + VDRL) and treatment of detected cases. The parameters for the exploratory exercise were obtained from systematic searches of indexed and grey literature and field work (EQ-5D questionnaire application and key actors interviews). Probabilistic sensitivity analysis was conducted to account for uncertainty in relevant parameters.
RESULTS: The proposed framework allows the evaluation of different detection strategies. In this study, all the strategies were cost-effective in the baseline scenario when considering an ICER threshold of 1 Chilean GDP per capita (US$15,000). The strategies most likely to be cost-effective (over 80% probability) were: current situation with reverse algorithm, entry point screening and mass screening every two years; the latter was the most effective, achieving the lowest prevalence (0.7% and 1.7% over the period versus the 3% prevalence in the current situation).
CONCLUSIONS: Mathematical modelling that considers the performance of different test and detection strategies could be a useful tool for decision making. The exploratory results show the efficiency of adopting both the use of the rapid tests and performing active case detection to significantly reduce the burden of syphilis in Chilean prisons in the near future.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- CERAsyphilisprison.pdf
Appendix 1. Mathematical models of the syphilis dynamics, costs, and health outcomes under different intervention strategies. Appendix 2. Tables of parameters: Exploratory exercise in a Chilean male prison.
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