Cost Effectiveness of Diagnostic Strategies for Opportune Detection of Toxoplasma Gondii in Pregnant Women

Documentos FCE CID Escuela de Economía N° 36 - Facultad de Ciencias Económicas de la Universidad Nacional de Colombia

42 Pages Posted: 15 Apr 2013

See all articles by Liliana Chicaíza

Liliana Chicaíza

Escuela de Administración de Empresas y Contaduría Pública

Mario García Molina

National University of Colombia - Department of Economics

Sandra Oviedo

National University of Colombia

Carlos Rincón

National University of Colombia

Jorge Gómez Marín

National University of Colombia

Edith Ángel Muller

National University of Colombia

Jorge Rubio-Romero

National University of Colombia

Ingrid Arévalo

National University of Colombia

Pío Gómez

National University of Colombia

Date Written: July 12, 2012

Abstract

Objective: To estimate the cost effectiveness ratio of performing serologic screening for toxoplasma in the first prenatal control and to continue or not with monthly or quarterly monitoring, to increase the diagnosed cases of pregnant women with Toxoplasma gondii infection with timely treatment.

Methods: We built a decision tree in TreeAge® which considered four diagnostic strategies: i) No screening ii) IgG and IgM for toxoplasma in the first prenatal visit, and the performance of an IgG avidity test and repetition in two weeks according with the results; iii) IgG and IgM for toxoplasma in the first prenatal control, performance of IgG avidity test and repetition in two weeks according with the results, and quarterly monitoring with IgM and iv) IgG and IgM for toxoplasma in the first prenatal control, performance of IgG avidity test and repetition in two weeks according with the results, and monthly monitoring with IgM. The costs were included from the perspective of the Colombian health system and expressed in Colombian pesos of 2010. Medicines cost information was obtained from the 2008 SISMED (1) and the value of the diagnostic tests was calculated by adjusting the values of the Tariff Manual ISS 2001 30% (2), these values were compared with information of the costs supplied by three EPS. The discount rate was 0%. We performed sensitivity univariate and probabilistic analyses for costs and effectiveness.

Results: The most effective and expensive strategy was found to be monthly monitoring, followed by quarterly monitoring, and no screening. Screening only in the first prenatal visit is a dominated strategy. The incremental cost-effectiveness ratio (ICER) of quarterly monitoring versus screening only in the first prenatal visit is $ 163,895,455; while the ICER of monthly versus quarterly monitoring is $ 418.906.009. According to the one-way sensitivity analysis, the variables that best explain the ICER variability are the incidence of congenital toxoplasmosis and the specificity of the IgM test. The probabilistic sensitivity analysis shows that, for a willingness to pay (WTP) below $175 million pesos it is more likely than not screening is a cost effective strategy. Between 175 million pesos and 407 million pesos, quarterly monitoring is more likely to be cost effective. For a WTP above $407 million pesos, the cost effective strategy is monthly monitoring.

Conclusions: The cost-effective strategy for Colombia depends on the WTP per additional case of Toxoplasma gondii infection in pregnant women opportunely detected and treated. The WTP should take into account the cost for society of neurological damage or blindness cases due to the infection.

Note: Downloadable document is in Spanish.

Keywords: Cost-benefit analysis, cost effectiveness, Health economics, pregnancy, infection

JEL Classification: D61, I10, I12, I19

Suggested Citation

Chicaíza, Liliana and García Molina, Mario and Oviedo, Sandra and Rincón, Carlos and Gómez Marín, Jorge and Ángel Muller, Edith and Rubio-Romero, Jorge and Arévalo, Ingrid and Gómez, Pío, Cost Effectiveness of Diagnostic Strategies for Opportune Detection of Toxoplasma Gondii in Pregnant Women (July 12, 2012). Documentos FCE CID Escuela de Economía N° 36 - Facultad de Ciencias Económicas de la Universidad Nacional de Colombia , Available at SSRN: https://ssrn.com/abstract=2194572 or http://dx.doi.org/10.2139/ssrn.2194572

Liliana Chicaíza (Contact Author)

Escuela de Administración de Empresas y Contaduría Pública ( email )

Carrera 30 45-03
Bogota, None
Colombia

Mario García Molina

National University of Colombia - Department of Economics ( email )

Carrera 30 Calle 45 Ciudad Universitaria
Bogotá
Colombia

HOME PAGE: http://www.unal.edu.co

Sandra Oviedo

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Carlos Rincón

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Jorge Gómez Marín

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Edith Ángel Muller

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Jorge Rubio-Romero

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Ingrid Arévalo

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Pío Gómez

National University of Colombia ( email )

Carrera 30 45-03
Bogota, None
Colombia

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
87
Abstract Views
1,323
Rank
619,411
PlumX Metrics