Modelling cost-effectiveness of syphilis detection strategies in prisoners: exploratory exercise in a Chilean male prison

Abstract Background Syphilis, together with other sexually transmitted infections, remains a global public health problem that is far from controlled. People deprived of liberty are vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence affordable alternatives would allow switching to active case-finding strategies. Our objective was develop mathematical modelling framework for cost-effectiveness evaluation, system perspective, different approaches using rapid tests detection syphilis inmates' populations and explore results based Chilean male prison Methods A compartmental model developed characterize transmission dynamics inside ongoing strategy (passive VRDL + FTA-ABS), considering entrance exit inmates over 40 year period. The allows simulation implementation reverse algorithm current situation (rapid test VDRL), screening strategies (entry point, massive periodically; both VDRL) treatment detected cases. parameters exploratory exercise were obtained systematic searches indexed grey literature field work (EQ-5D questionnaire application key actors interviews). Probabilistic sensitivity analysis conducted account uncertainty relevant parameters. Results proposed evaluation In this study, all cost-effective baseline scenario when an ICER threshold 1 GDP per capita (US$15,000). most likely be (over 80% probability) were: algorithm, entry point mass every two years; latter effective, achieving lowest prevalence (0.7% 1.7% period versus 3% situation). Conclusions Mathematical considers performance could useful tool decision making. show efficiency adopting use performing significantly reduce burden near future.