Estudio de costo-efectividad de las pruebas rápidas treponémicas realizadas en el laboratorio clínico vs. las realizadas en consultorio médico para el control de sífilis congénita, basado en real world data, en el Instituto Materno Infantil de la Subred Integrada de Servicios de Salud Centro Oriente E.S.E. Bogotá D.C, durante los años 2016 a 2018.
Thesis
Pregnant women infected with syphilis can transmit the infection to the fetus (congenital syphilis), which causes serious adverse pregnancy outcomes in 80% of cases (Apolinar, 2017). For the prevention of motherto-child transmission of syphilis, in the month of June 2017, the study institution begins with the rapid test intervention applied in the office, during the maternal care, changing the diagnostic scheme and treatment opportunity. In gestational and congenital syphilis. This motivated the real cost effectiveness study based on Real World Data, in order to provide the calculation of associated costs in each of the two alternatives and thus define which is the most economical and effective for the institution and the system. Of health. The study reviews 261 medical records of pregnant women diagnosed with gestational syphilis between 2016 and 2018, and selects a sample of those that met the requirements for applying treponemic rapid tests at the point of care or in the clinical laboratory for diagnosis. Of gestational syphilis, performed 30 or more days before delivery and adequate treatment by administering the first dose of benzathine Penicillin 2,400,000 IU intramuscular. Methodology. A cost effectiveness evaluation study was carried out based on real world data, with a time horizon of 14 days from the date of delivery, based on the PICO question, the opportunity variables were evaluated both in diagnosis and treatment, costs of the rapid tests, costs of patients with congenital syphilis, estimated effects of the application of the two syphilis diagnostic strategies and an incremental costeffectiveness ratio. The decision tree model was developed in the PrecisionTree 5.5 software. For the statistical analysis, the Microsoft Excel 365 software, R and SPSS software were used, and the Oracle Crystal Ball software was used for the sensitivity analysis. Results. It is evident that rapid tests performed at the point of care is the dominant technology with respect to rapid tests performed in the laboratory; Statistical evidence shows that the rapid test-delivery opportunity and the rapid treatment-test opportunity are statistically significant to explain cases of congenital syphilis. There is statistical evidence that there is a difference between the opportunity time from the diagnosis of syphilis by means of the rapid test to the treatment in the laboratory of 28.16 days and that in the office of 0 days. Statistical evidence shows that there is a difference between the time of the medical consultation, until the rapid test carried out in the 30-minute office, compared to 195.72 minutes in the clinical laboratory.
