Direct Cost Analysis of Diagnostic Pathways for Acute Vulvovaginal Candidiasis in Uganda: A Modeling Study.

Authors

Jonani Bwambale, Nakitende Patricia Peace, Ssebunya Enock, Gerald Mboowa, Anita Kisakye, Abel W Walekhwa, Felix Ocom, Alex R Ario, Betty Kivumbi Nannyonga

Published in

Open forum infectious diseases. Volume 13. Issue 10. Pages ofag624. Epub Oct 01, 2026.

Abstract

Vulvovaginal candidiasis (VVC) is commonly managed syndromically or investigated using fungal culture. This study compared direct medical costs of 3 diagnostic pathways for acute VVC in Uganda.
A decision-analytic cost model compared syndromic management, culture-based diagnosis, and microscopy-based diagnosis in a hypothetical cohort of 1000 symptomatic women. The proportion classified by the microscopy-based framework as meeting the model criteria for antifungal treatment (10.1%) was derived from 447 high vaginal swab records at Sebbi Hospital (2022-2025). Laboratory and antifungal costs were obtained from procurement records and Uganda Joint Medical Stores prices. The culture-based pathway incorporated a return-visit consultation fee. One-way sensitivity analyses were conducted, and a societal-perspective scenario used to assess cost differences between pathways.
Total direct costs per 1000 women were US dollar (USD) 10 761 for syndromic management, USD 35 565 for culture-based diagnosis, and USD 14 996 for microscopy-based diagnosis. Culture-based diagnosis was the costliest pathway under every condition examined, exceeding microscopy-based diagnosis by USD 20 568 and syndromic management by USD 24 804. Microscopy-based diagnosis did not generate net savings over syndromic management at base-case public-sector antifungal prices. The cost difference was most sensitive to the unit cost of microscopy and antifungal treatment. Selective fungal culture increased the cost of the microscopy-based pathway in a separate scenario analysis. For the base-case microscopy-based pathway, without selective fungal culture, the break-even antifungal unit price was USD 6.01 per treatment episode.
Under the modeled assumptions, microscopy-based diagnosis becomes less costly than syndromic management when the antifungal treatment price exceeded the base-case break-even threshold.

PMID:
42892818
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.