Cost-effectiveness of five strategies for gonorrhea and chlamydia control among female and male emergency department patients.
BACKGROUND
Previous studies have shown screening for gonorrhea and chlamydia to be cost-effective for limiting the sequelae of infection and the associated costs of management.


OBJECTIVE
To evaluate the cost-effectiveness of enhanced screening for gonorrhea and chlamydia in an emergency department (ED) setting.


METHODS
Five strategies were compared with use of decision analysis for theoretical cohorts of 10,000 female and 10,000 male ED patients aged 18 years to 31 years: standard ED practice, three enhanced screening strategies, and mass treatment. Main outcome measures were untreated gonorrhea or chlamydia cases and their sequelae, transmission to a partner, congenital outcomes, and cost to prevent a case. This analysis, from the perspective of the healthcare sector, included medical case costs expressed in US dollars (1999), discounted at an annual rate of 3%.


RESULTS
Mass treatment was the most cost-effective strategy among women and men. Of the screening strategies for women, universal screening combined with standard practice was the most cost-effective; it was used for treating 499 more cases of gonorrhea and chlamydia than was standard practice, saving $95.70 per case treated. Standard ED practice remained the most cost-effective strategy for men under a variety of circumstances.


CONCLUSIONS
The authors recommend urine ligase chain reaction screening for gonorrhea and chlamydia in women aged 18 years to 31 years in the ED, in conjunction with standard ED practice, to decrease the occurrence of the sequelae and costs associated with infection.
Mehta
Supriya D
SD
Department of Medicine, Division of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Bishai
David
D
Howell
M Rene
MR
Rothman
Richard E
RE
Quinn
Thomas C
TC
Zenilman
Jonathan M
JM
D000293:Adolescent; D000328:Adult; D015142:Baltimore; D002690:Chlamydia Infections / Q000191:economics / Q000517:prevention & control* / Q000652:urine; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006069:Gonorrhea / Q000191:economics / Q000517:prevention & control* / Q000652:urine; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods