Cohort III-2 58,569 Aim: to determine the clinical utility and cost of In all, 113 new cases of syphilis occurred (Shiber & repeating syphilis testing in the third trimester of (192.9/100,000 deliveries). There were 17 Todia 2014) pregnancy in a high-risk urban population. detected seroconversions; 10 were not rescreened in the third trimester and Setting: United States tested positive at delivery. These 10 Methods: A retrospective cohort analysis was patients may have benefitted from performed for patients delivering from January implementing uniform VDRL testing at 1993 through December 2009 with at least 1 weeks’ gestation. All newborns were venereal disease research laboratory (VDRL) test asymptomatic with a negative workup and sent during pregnancy. Chart review was performed received empiric penicillin therapy. Based for patients with confirmed syphilis to determine on 2011 hospital charges, the cost of the temporal relationship of syphilis diagnosis to evaluating and treating a neonate for the pregnancy. For patients who seroconverted syphilis is $11,079. Implementing an during pregnancy (no antecedent history or additional VDRL screen at 28-32 weeks’ treatment for syphilis), newborn charts were gestation for each pregnant patient during reviewed. The costs of treating seropositive the 17 years studied would cost $1,991,346. neonates and the costs of implementing additional An 18-fold increase in syphilis prevalence third-trimester syphilis screening were then (3500/100,000 [3.5%] deliveries) would be compared. required for the cost of implementation of universal early third-trimester screening to be equal to the potential health care charges saved by detecting maternal seroconversion and obviating the need for neonatal therapy.
(Shiber & Todia 2014) Cohort III-2 58,569 Aim: to determine the clinical utility and cost of repeating syphilis testing in the third trimester of pregnancy in a high-risk urban population. Setting: United States Methods: A retrospective cohort analysis was performed for patients delivering from January 1993 through December 2009 with at least 1 venereal disease research laboratory (VDRL) test sent during pregnancy. Chart review was performed for patients with confirmed syphilis to determine the temporal relationship of syphilis diagnosis to the pregnancy. For patients who seroconverted during pregnancy (no antecedent history or treatment for syphilis), newborn charts were reviewed. The costs of treating seropositive neonates and the costs of implementing additional third-trimester syphilis screening were then compared. In all, 113 new cases of syphilis occurred (192.9/100,000 deliveries). There were 17 detected seroconversions; 10 were not rescreened in the third trimester and tested positive at delivery. These 10 patients may have benefitted from implementing uniform VDRL testing at weeks’ gestation. All newborns were asymptomatic with a negative workup and received empiric penicillin therapy. Based on 2011 hospital charges, the cost of evaluating and treating a neonate for syphilis is $11,079. Implementing an additional VDRL screen at 28-32 weeks’ gestation for each pregnant patient during the 17 years studied would cost $1,991,346. An 18-fold increase in syphilis prevalence (3500/100,000 [3.5%] deliveries) would be required for the cost of implementation of universal early third-trimester screening to be equal to the potential health care charges saved by detecting maternal seroconversion and obviating the need for neonatal therapy.
Syphilis%20evidence%20evaluation%2015Oct18.DOCX