Table 1.

Key characteristics of health economic evaluations related to syphilis infection

Lead author	Evaluation aims	Country	Population targeted by the intervention	Health states included	Source for disability weights or utility weights
Primary outcome: DALYs
Bristow (2016) [21]	Assess the health and economic outcomes of a dual testing strategy in a simulated cohort of antenatal care patients in Malawi	Malawi	Women attending antenatal clinic	Congenital syphilis, low birth weight, neonatal death, stillbirth	[76]
Hong (2010) [22]	Assess the effectiveness of a program preventing mother-to-child transmission of syphilis	China	Women attending antenatal clinic	Congenital syphilis	[44, 77]
Jayawardena (2019) [23]	Analyse alternative options for donor syphilis testing to determine the optimal strategy	Australia	Blood donors	Adult early syphilis, adult tertiary syphilis, congenital syphilis	[45, 78] Durations from [79]
Kahn (2014) [24]	Assess the cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care programs in various contexts	Modelled scenarios in generic countries	Women attending antenatal clinic	Congenital syphilis, low birth weight, stillbirth, neonatal death	[76]
Kuznik (2013) [25]	Evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in sub-Saharan Africa and estimate the impact of universal screening on outcomes	43 sub-Saharan African countries	Women attending antenatal clinic	Congenital syphilis, stillbirth, neonatal death	[45]
Kuznik (2015) [26]	Evaluated the cost-effectiveness of increasing the coverage for antenatal syphilis screening in 11 Asian and 20 Latin American countries using a POC test compared to no testing and no treatment	11 Asian and 20 Latin American countries	Women attending antenatal clinic	Congenital syphilis, stillbirth, neonatal death	[80]
Larson (2014) [27]	Estimate the costs and cost-effectiveness of using rapid syphilis POC tests compared to usual care	Zambia	Women attending antenatal clinic	Congenital syphilis, low birth weight, stillbirth, neonatal death	[24]
Owusu-Edusei (2011) [28]	Compare the health and economic outcomes of a dual nontreponemal-treponemal point-of-care test with existing syphilis tests/testing algorithms in a high prevalence setting	Sub-Saharan Africa	Women attending antenatal clinic	Adult early syphilis, adult tertiary syphilis, congenital syphilis, low birth weight, miscarriage, stillbirth, neonatal death	[64]
Owusu-Edusei (2014) [29]	Compare the economic and health outcomes of four new antenatal HIV and syphilis screening strategies	China	Women attending antenatal clinic	Adult early syphilis, adult tertiary syphilis, HIV-positive women with syphilis coinfection, congenital syphilis, low birth weight, stillbirth, induced abortion for infected mothers, neonatal death, HIV in newborn	[45]
Rodriguez (2021) [30]	Assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence	South Africa, Kenya, Colombia, Ukraine	Women attending antenatal clinic	Congenital syphilis, low birth weight, stillbirth, neonatal death	[10]
Romero (2020) [31]	Assess the cost-effectiveness of a rapid point-of-care test and treatment if required compared with a laboratory-based standard test with treatment at the next follow-up visit	Brazil	Women attending antenatal clinic	Congenital syphilis, low birth weight, stillbirth, neonatal death	[54]
Russell (2021) [41]	Estimate the cost-effectiveness of testing all blood donations for HIV, hepatitis B and C, and syphilis to avoid adverse health outcomes in recipients	Ghana	Patients receiving blood transfusions	Acute syphilis infection	[42]
Schackman (2007) [32]	Estimate the cost-effectiveness, projected health outcomes, and the annual cost of screening pregnant women using a rapid syphilis test	Haiti	Women attending antenatal clinic	Congenital syphilis, stillbirth, neonatal death	[64]
Terris-Prestholt (2003) [33]	Estimate the cost-effectiveness of on-site antenatal syphilis screening and treatment	Tanzania	Women attending antenatal clinic	Low birth weight, stillbirth	[44]
Terris-Prestholt (2015) [34]	Assess the cost-effectiveness of clinic-based rapid plasma reagin and single rapid syphilis test in 20 antenatal clinics across Peru, Tanzania, and Zambia	Peru, Tanzania, Zambia	Women attending antenatal clinic	Congenital syphilis, low birth weight, stillbirth, neonatal death	Partially from [25]
Primary outcome: QALYs
Castillo (2021) [40]	Develop a modelling framework for cost-effectiveness evaluation of different approaches using rapid tests for the detection of syphilis in inmates’ populations	Chile	Prisoners	Adult syphilis infection (susceptible, stage 1, stage 2, latent, tertiary, immune)	[81, 82]
Custer (2010) [42]	Assessed the cost-effectiveness of pathogen reduction technology in mitigating the risk of transfusion-associated infectious and some non-infectious threats	Canada	Patients receiving blood transfusions	Primary syphilis, tertiary syphilis	Assumption for primary syphilis; For tertiary syphilis [57]
Eaton (2018) [35]	Compare the cost-effectiveness of the reverse and traditional syphilis screening algorithms in persons living with HIV	United States	People living with HIV	HIV and syphilis infection	[39]
Hersh (2018) [36]	Estimate the cost-effectiveness of screening all women during the first and third trimesters compared with screening just once during pregnancy	United States	Women attending antenatal clinic	Congenital syphilis, intrauterine fetal demise, neonatal death, congenital syphilis (maternal perspective), intrauterine fetal demise (maternal perspective), neonatal death (maternal perspective)	For fetal perspectives [58] For maternal perspectives [83, 84]
Huntington (2020) [37]	Assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women	United Kingdom	Women attending antenatal clinic	Congenital syphilis, intrauterine fetal demise, neonatal death	[58]
Suijkerbuijk (2018)a [38]	Evaluate intended savings and missed syphilis and/or HIV infections and explore the efficiency of possible test policies	Netherlands	People attending a sexual health clinic	Syphilis	[53]
Tuite (2014)a [39]	Evaluate the cost-effectiveness of strategies that increased the frequency and population coverage of syphilis screening in HIV-infected men who have sex with men receiving HIV care relative to the current standard of care	Canada	Men who have sex with men living with HIV	Primary syphilis, secondary syphilis, neurosyphilis and tertiary syphilis	[45, 85]

POC Point of care, HIV Human immunodeficiency virus

^aStudies used disability weights for valuation of health states but calculated their outcomes in terms of QALYs