Risk-based versus alternative algorithms for antibiotic prophylaxis among women seeking early suction abortion - A cost-effectiveness simulation

Background. Particularly in resource-poor settings, simple, inexpensive, an d cost-effective algorithms are needed to direct antibiotic prophylaxis to prevent sequelae of infections with Chlamydia trachomatis, Neisseria gonorr hoeae, and bacterial vaginosis-associated organisms among women undergoing abortion. Goal. To assess the prevalence of and risk factors for infections among wom en seeking abortion in Bali, Indonesia, and to use these data in designing a cost-effective risk-based prophylaxis algorithm. Study Design: A cross-sectional analysis and data-based simulation of risk- based and alternative prophylaxis algorithms were performed. Results: The risk-based algorithm would have provided prophylaxis to 70% (9 5% Cl, 53-83%) of women with cervical infection, 64% (95% CI, 54-74%) of th ose with bacterial vaginosis, and 57% (95% Cl, 42-72%) of those with tricho moniasis. For cervical infection, the algorithm was more cost effective tha n all others evaluated. The cost-effectiveness was acceptable for bacterial vaginosis. Conclusions: Risk-based algorithms may be cost effective in identifying wom en likely to benefit from preabortion prophylaxis. Prospective evaluation i s needed to validate these findings.