A cost-effectiveness analysis of interventions to increase repeat testing in patients treated for gonorrhea or chlamydia at public sexually transmitted disease clinics.
BACKGROUND
Persons who have been infected with chlamydia or gonorrhea (CT/GC) are at elevated risk for reinfection. The cost-effectiveness of interventions designed to encourage public sexually transmitted disease (STD) clinic patients to return for rescreening has not been well-evaluated.


OBJECTIVE
The goal of this study was to conduct a program- and societal-perspective cost-effectiveness analysis of five interventions designed to encourage public STD clinic patients infected with CT/GC to return for rescreening 3 months after initial treatment.


METHODS
Researchers at two STD clinics collected cost data for the five interventions. These were combined with study data on return rates and CT/GC positivity rates among returning patients to compare the cost-effectiveness of the interventions.


RESULTS
The cost per patient counseled with a brief recommendation to return, followed by a telephone reminder after 3 months, was higher than two interventions: a brief recommendation to return with no reminder and a $20 incentive, received on return. However, the brief recommendation with a telephone reminder yielded the highest return rate (33%) and was the least costly in terms of cost per infection treated ($622 program, $813 societal). In-depth motivational counseling that helped clients identify risk factors and provided reasons for returning was more costly than a phone reminder alone and was not more effective.


CONCLUSIONS
Phone reminders are more cost-effective than motivational counseling and improve return rates over a brief recommendation given at the time of initial treatment.
Gift
Thomas L
TL
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. tgift@cdc.gov
Malotte
C Kevin
CK
Ledsky
Rebecca
R
Hogben
Matthew
M
Middlestadt
Susan
S
VanDevanter
Nancy L
NL
St Lawrence
Janet S
JS
D002690:Chlamydia Infections / Q000191:economics* / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D003376:Counseling / Q000191:economics; D006069:Gonorrhea / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D009042:Motivation; D015397:Program Evaluation / Q000191:economics; D017010:Reminder Systems / Q000191:economics; D013689:Telephone / Q000191:economics