Table 2. 4-year cost-effectiveness of the MTCT of syphilis elimination program compared to current screening and treatment in 8 country scenarios.

Country scenario*					Cost-effectiveness findings **
Scenario	Syphilis prevalence in ANC	Current ANC screening & treatment coverage	Cost of health services	DALYs averted (4 years)	Cost of intervention (4 years)	Offsetting savings***(4 years)	Net cost/savingŝ	Cost per DALY averted
A	High	Low	Low	93,484	$4,329,722	$6,272,739	−$1,943,017	<$0
B	High	Low	High	93,484	$5,381,458	$17,642,708	−$12,261,250	<$0
C	High	High	Low	34,518	$6,629,636	$7,395,199	−$765,563	<$0
D	High	High	High	34,518	$8,235,796	$12,823,574	−$4,587,778	<$0
E	Low	Low	Low	15,584	$4,142,287	$2,405,480	$1,736,807	$111
F	Low	Low	High	15,584	$5,190,243	$4,646,771	$543,472	$35
G	Low	High	Low	5,754	$6,327,564	$5,734,376	$593,188	$103
H	Low	High	High	5,754	$7,927,633	$7,787,351	$140,282	$24

Costs are in 2010 USD

^*Scenario classifications are: prevalence of syphilis  =  high (3%) or low (0.5%), current ANC screening and treatment coverage  =  high (70%) or low (20%), cost of health services reflects assumptions about the overall relative health care cost structure, including the cost of MTCT of syphilis AOs, i.e. high (1) or low (0.25) based on WHO CHOICE data (http://www.who.int/choice/en/).

^**Cost and effectiveness compared to current screening and treatment services

^***Offsetting savings  =  costs of net averted MTCT of syphilis and net averted adult STI plus costs of current services replaced by expanded program

? Savings denoted by negative costs