Abstract

CHICAIZA-BECERRA, Liliana et al. Cost effectiveness of various diagnostic strategies for detecting congenital toxoplasmosis in newborns. Infect. [online]. 2013, vol.17, n.2, pp.53-60. ISSN 0123-9392.

Objectives: To evaluate the cost-effectiveness in Colombia of strategies for congenital toxoplasmosis detection in newborns of mothers with a history of infection. Methods: We built a decision tree in TreeAge ®, with correctly identified outcome cases and considering 3 diagnostic strategies: A) Western Blot (WB); B) IgM and IgA, with WB confirmation; and C) IgG, IgM and IgA, with WB confirmation and IgG monitoring. The perspective is that of the Colombian health system. Prices are expressed in Colombian pesos (COP, 2010) with no discount. Results: The least expensive and least efficient strategy was option A. Option B had a higher cost and higher effectiveness, and option C was the most expensive and effective strategy. The incremental cost effectiveness ratio (ICER) of strategy B versus A was COP 6,189,871. This ICER is sensitive to the cost and sensitivity of the WB and to the prevalence of congenital toxoplasmosis. The ICER for strategy C versus B was COP 65,529,979, which was sensitive to the prevalence of congenital toxoplasmosis, the sensitivity of the joint IgM and IgA test and the sensitivity of the WB. According to the probabilistic sensitivity analysis, if the willingness to pay (WTP) for each additional detected case of congenital toxoplasmosis is lower than COP 6.7 million, option A is more likely to be cost-effective. If the WTP is between COP 6.7 million and COP 74 million, option B is more likely to be cost-effective, and if the WTP is above COP 74 million, then option is more likely to be cost-effective. Conclusions: The cost-effective alternative for Colombia depends on the willingness to pay for additional cases of detected congenital toxoplasmosis. WTP should take into account treatment effectiveness and the costs of the infection sequelae.

Keywords : Congenital toxoplasmosis; Newborns; Cost-benefit analysis; Colombia.

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