Effectiveness and cost-benefit of enhancements to a syphilis screening and treatment program at a county jail.
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.
Silberstein
G S
GS
New York State Department of Health, Albany, USA.
Coles
F B
FB
Greenberg
A
A
Singer
L
L
Voigt
R
R
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*