NAAT plus wet mount is cost-effective for symptomatic trichomoniasis screening in US primary care
Investigators evaluated the cost-effectiveness of 11 diagnostic strategies for Trichomonas vaginalis using a decision-tree model of 8,000 US women aged 15 to 59. Adding nucleic acid amplification testing to wet mount microscopy for symptomatic patients yielded 0.3 quality-adjusted life years at an incremental cost-effectiveness ratio of $83,097 per QALY, meeting standard willingness-to-pay thresholds. In contrast, pairing NAAT with rapid antigen testing or screening asymptomatic women universally with NAAT proved economically unjustified at conventional benchmarks. The analysis supports integrating NAAT into current wet mount workflows for symptomatic patients while cautioning against broad asymptomatic screening in US outpatient settings.
The original study
Cost-Effectiveness of Testing and Screening Strategies for Trichomoniasis among Asymptomatic and Symptomatic Women in U.S. Outpatient Clinical Settings.
- Authors
- Rong R, Stoecker C, Kissinger PJ, Muzny CA
- Journal
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Type
- Journal Article
- PMID
- 42570009
Original abstract
BACKGROUND: T. vaginalis, the most common non-viral sexually transmitted infection among women, is associated with multiple adverse health outcomes. Screening asymptomatic women is not recommended except among HIV-infected women. We aimed to evaluate the cost-effectiveness of T. vaginalis testing and screening strategies among asymptomatic and symptomatic women, respectively, in U.S. primary care settings. METHODS: We developed a decision tree model to evaluate 11 testing/screening strategies (using combinations of wet mount microscopy, rapid antigen testing, and T. vaginalis nucleic acid amplification testing [NAAT]) for a hypothetical cohort of 8,000 women aged 15-59 years presenting to U.S. primary care clinics in 2023. We estimated the risk, societal economic burden, and quality-adjusted life year (QALY) losses for trichomonas sequelae-preterm birth, low birthweight, premature rupture of membranes, HIV infection, and cervical cancer-over the cohort's lifetime. RESULTS: Adding T. vaginalis NAAT to wet mount for symptomatic women provided 0.3 additional QALYs at an incremental cost of $24,785 (ICER: $83,097/QALY). Adding NAAT to rapid antigen testing for symptomatic women yielded 0.1 additional QALYs at an incremental cost of $35,628 (ICER: $324,617/QALY). Screening asymptomatic women with NAAT cost $403,541/QALY. CONCLUSIONS: Incorporating NAAT into current testing practices for symptomatic women improved health outcomes but increased costs. At a willingness-to-pay threshold of $100,000/QALY, adding NAAT to wet mount for symptomatic women was cost-effective whereas adding NAAT to rapid antigen testing was not. Universal NAAT screening among asymptomatic women was also not cost-effective, suggesting that broader screening strategies may require substantially higher willingness-to-pay thresholds to be economically justified.