A COST COMPARISON OF APPROACHES TO SEXUALLY-TRANSMITTED DISEASE TREATMENT IN MALAWI

Since syndromic management of STDs requires treatment with at least tw o antibiotics per patient, one of the concerns raised by adoption of t he syndromic approach is the cost of drugs, especially for developing countries with limited drug budgets. The objective of the current stud y is to compare the cost-effectiveness of syndromic management to curr ent national practice for the management of STDs in Malawi. The actual cost of observed antibiotic treatment for 144 patients receiving same day treatment for two STD syndromes in Malawi was determined using pr ices from the Malawi government supply catalogue. This was then compar ed to the calculated cost of treatment had the same patients been mana ged syndromically according to national guidelines. The cost of drug t reatment under current practice was similar to the cost of syndromic t reatment. However, at least one-third of observed patients did not rec eive effective treatment for either likely cause of their STD syndrome and wastage accounted for 54% of total observed drug cost. Overall, s yndromic management of STDs in Malawi would result in more effective t reatment of STDs at no additional cost. Since the indirect costs of lo w treatment efficacy were not taken into account in this analysis, a n et saving is likely to be realized with the adoption of syndromic mana gement.