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Published on: October 23, 2011
Cost-effectiveness analysis of bacterial vaginosis screening strategies in women attempting for natural conception
Dengyan Qi1, Hanyue Zheng1, Mengjie Zhao1
1Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China.
Objectives:
Bacterial vaginosis (BV) is associated with reduced fecundability in women. To address the limited accessibility and diagnostic sensitivity of current preconception BV screening in China, this study evaluated the cost-effectiveness of BV Blue, an accessible, self-administered rapid test.
Methods:
A decision tree model was constructed from a societal perspective to compare five screening strategies: No screening, Amsel criteria, BV Blue testing alone, sequential BV Blue-Nugent testing, and Nugent scoring alone. Effectiveness was defined as the number of pregnancies per 100,000 women over one year. Cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs), referenced against a willingness-to-pay (WTP) threshold based on China's per capita GDP. Sensitivity analyses were conducted to assess model robustness.
Results:
In a simulated cohort of 100,000 women, BV Blue testing yielded 842 additional pregnancies compared with no screening (ICER: CNY 2,827 per pregnancy), well below the WTP threshold of CNY 99,665. The sequential and Amsel strategies were absolutely dominated by BV Blue testing. Compared with BV Blue testing, Nugent strategy yielded 171 additional pregnancies (ICER: CNY 198,051 per pregnancy), remaining below the three-fold per capita GDP threshold (CNY 298,995). However, sensitivity analyses indicated that the cost-effectiveness of Nugent strategy was not robust, being highly sensitive to BV Blue testing's diagnostic sensitivity and pregnancy rates. On the cost-effectiveness acceptability curve, BV Blue testing consistently demonstrated the highest probability of being the optimal strategy.
Conclusion:
In the preconception period, all screening strategies yielded more pregnancies than no screening. Both BV Blue testing and Nugent scoring were cost-effective, whereas the Amsel and sequential strategies were not. BV Blue testing is a promising screening tool for preconception BV management. These findings may inform the selection of diagnostic pathways in China's national preconception screening program.
