title: Effectiveness and cost-benefit of enhancements to a syphilis screening and treatment program at a county jail.
abstract: BACKGROUND
  High rates of syphilis are found in inmates of county jails. Treatment of this infected transient population necessitated the development of a rapid protocol.
  
  
  OBJECTIVE
  To evaluate a rapid screening and treatment protocol for syphilis in a county jail.
  
  
  METHODS
  Over a 2-year period 18,442 inmates were screened for syphilis with a nontreponemal test and record search for treatment history. Confirmatory test results were reviewed following treatment. Cost was defined as deflated marginal outlays. Benefit was calculated as the discounted expected cost of treatment of congenital, late, and neurosyphilis.
  
  
  RESULTS
  The sensitivity, specificity, and positive predictive value of the protocol were 99.6%, 80.8%, and 79.3%, respectively. Of 257 confirmed cases, 183 were offered treatment in jail. The percentage of short-term inmates treated increased following implementation. The cost-benefit ratio was 9.14:1.
  
  
  CONCLUSIONS
  The protocol was highly effective in patient identification and treatment delivery, and cost-effective as well.
authors.affiliation: New York State Department of Health, Albany, USA.
authors.forename: G S
authors.initials: GS
authors.lastname: Silberstein
authors.forename: F B
authors.initials: FB
authors.lastname: Coles
authors.forename: A
authors.initials: A
authors.lastname: Greenberg
authors.forename: L
authors.initials: L
authors.lastname: Singer
authors.forename: R
authors.initials: R
authors.lastname: Voigt
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009518:New York; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011329:Prisoners; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control* / Q000652:urine; D013588:Syphilis Serodiagnosis / Q000191:economics* / Q000592:standards*