Estimating the Direct Medical Cost of Syphilis in China

Abstract Background Few studies investigating the direct medical cost of syphilis was conducted in developing countries, including China. Methods The main tasks of our study were to estimate the direct medical costs of syphilis in China at subnational level, and to characterize the distribution of the direct medical cost of syphilis in 31 Chinese provincial districts in relation to GDP. Data on medical expenses for syphilis patients diagnosed at Peking Union Medical College Hospital (PUMCH) was used to estimate direct medical cost per case, which was then multiplied by the number of newly reported cases of syphilis in China to yield the absolute medical cost for syphilis. Relative costs, defined as the absolute costs in per million of gross domestic product (GDP), was also calculated. Comparisons of direct medical cost represented as absolute cost and relative cost respectively, in different years and different provincial districts were conducted. Gini index was used to characterize the distribution of syphilis cases and direct medical cost of syphilis at provincial level. Results Average cost of patients with follow-up more than 36 month was regarded as the most reasonable estimate of direct medical cost per case, and was obtained as US $ 134.43 in primary syphilis, US $ 119.24 in secondary syphilis, US $ 503.76 in tertiary syphilis and US $ 97.59 in latent syphilis. Absolute medical cost of syphilis in China increased from US $ 11.15 million to US $46.89 million from 2004 to 2016. Relative cost in China increased from 2.85 to 5.26 per million of GDP from 2004 to 2010, and decreased from 5.26 to 3.99 per million of GDP from 2010 to 2016. The largest relative cost was always observed in western region. Between 2009 and 2016, a large relative medical cost was observed in 7 to 9 provinces in western region, 3 to 5 provinces in eastern region, 1 to 4 provinces in central region, 1 to 2 provinces in northeastern region. The level of inequality decreased from 2010 to 2016, and kept a continuously moderate equality from 2012 to 2016. Conclusion This study provided a rough estimate of the direct medical costs of syphilis in China and its distribution pattern in 31 Chinese provincial districts. The results highlight that syphilis caused a huge economic burden in China, which distributed disproportionally within provinces. Western region bore a huge and increasing economic burden, while the economic burden in eastern region had once been huge, but tending to decline. Thus, more active and effective control are needed, and strategies on the prevention and control of syphilis be managed according to local conditions.