Modelling the cost per ulcer treated of incorporating episodic treatment for HSV-2 into the syndromic algorithm for genital ulcer disease

Abstract

In certain scenarios, including HSV-2 treatment can increase the number of ulcers treated and reduce the cost per ulcer treated of GUD syndromic management.

Prevalence and Associations of Genital Ulcer and Urethral Pathogens in Men Presenting With Genital Ulcer Syndrome to Primary Health Care Clinics in South Africa

“…19 However, few countries have taken up this recommendation despite the existence of cost-effectiveness modeling data. 20 Our observation that genital herpes accounts for almost three quarters of all cases of GUD supports other African studies. 21 The dramatic decrease in the relative prevalence of chancroid may be attributed in part to the syndromic management approach.…”

Etiology of Genital Ulcer Disease in a Sexually Transmitted Infection Reference Center in Manaus, Brazilian Amazon

“…The addition of acyclovir was found to increase the number of ulcers correctly treated thereby reducing the cost per ulcer treated in certain scenarios. [51] So far, few countries have taken up this recommendation. [25], [49] Brazil is currently employing the 2003 WHO syndromic management that only includes antiviral treatment for HSV2 for anyone with typical symptoms/signs.…”

Sexually Transmitted Infections: Impact and Cost-Effectiveness of Prevention

“…A savings of US$2.39 occurred per additional patient appropriately managed for urethral discharge in males and vaginal discharge and lower abdominal pain in females. Vickerman, Ndowa, and Mayaud 2008 Modification in STI treatment guidelines for syndromic management of genital ulcer disease that incorporated antiviral treatment for HSV-2 in certain situations.…”

“…• An intervention in Durban, South Africa, that provided syndromic management packets (including an information leaflet and appropriate antibiotics) to primary care clinics was found to cost US$2.39 per additional patient appropriately managed for urethral discharge in males and vaginal discharge and lower abdominal pain in females (Colvin and others 2006). • Vickerman, Ndowa, and Mayaud (2008) examined the cost-effectiveness of a modification in the 2003 WHO guidelines for syndromic management of genital ulcer disease that incorporated antiviral treatment for HSV-2 in certain situations, such as in populations with HSV-2 prevalence of 30 percent or more. Although the incorporation of HSV-2 treatment could increase program costs, it could potentially increase the proportion of herpetic ulcers treated while reducing the cost per ulcer appropriately treated.…”