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The average sequelae costs averted by syphilis treatment are not known with precision.
All other sequelae costs were determined as the result of the disease progression.
This assumption reduced the expected sequelae costs of untreated syphilis by more than half, thereby making the estimates of the costs averted by syphilis treatment more conservative.
Including seven patients with severe neurological sequelae, costs per life year gained in 5-year survivors increased by 18% to 11,566 €.
Treatment and sequelae costs averted by reducing STIs in the population varied substantially as well, given the uncertainty in estimating the population-level benefits of STI treatment of individuals.
To calculate the treatment and sequelae costs averted by the interruption of STI transmission, we applied published estimates of the average lifetime cost per case of syphilis, gonorrhea, and chlamydia, as these estimates incorporate the probability and cost of STI treatment as well as the probability and cost of adverse sequelae in the absence of treatment.
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The average treatment and sequelae cost per case of syphilis we applied ($572) was the same value we applied above for the sequelae cost averted per case of syphilis treated, because when calculating the sequelae cost of syphilis averted by treatment we allowed for the possibility of subsequent treatment for syphilis before the advent of sequelae.
38, 39 The model implicitly takes these factors into account, as the transition probabilities and sequelae cost incorporate some level of alcohol consumption and metabolic syndrome.
For chlamydia, the formula includes the absolute reduction in the probability of sequelae associated with treatment (0.16 for women and 0.03 for men), the sequelae cost ($1,995 for women and $274 for men), an adjustment (0.925) to prevent double-counting of benefits of treating people with both gonorrhea and chlamydia, and an adjustment (0.70) to account for the possibility of re-infection.
The sequelae occurrence costs were then added together per concept to provide a typical cost per concept occurrence.
Although our analyses were similar around assumptions on utilities, incidence of disease sequelae, and costs, Chuck et al. assumed a greater rate of mortality.
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