The cost-effectiveness of an outreach clinical model in the management and prevention of gonorrhea and chlamydia among Chinese female sex workers in Hong Kong.
BACKGROUND
Social marginalization and stigmatization in usual medical care setting may refrain female sex workers (FSWs) from seeking usual medical care for sexually transmitted infections in Hong Kong.


OBJECTIVE
To evaluate the cost-effectiveness of using an outreach approach for treatment and prevention of gonorrhea and chlamydia among FSWs.


METHODS
A decision tree was designed to simulate the outcomes of 2 alternatives: (1) outreach service providing treatment of gonorrhea and chlamydia and counseling to FSWs (outreach arm) and (2) no outreach service (control arm). Five tiers of outcomes were estimated for each study arm: (1) total direct medical cost, (2) number of FSWs infected with gonorrhea, (3) number of new cases of gonorrhea in clients transmitted by FSWs, (4) number of FSWs infected with chlamydia, and (5) number of new cases of chlamydia in clients transmitted by FSWs. Clinical inputs were estimated from literature, and cost analysis was conducted from the perspective of a public health organization.


RESULTS
Compared to the control group, the marginal savings per new case of infection averted (marginal cost divided by marginal cases of infection) of the outreach group were $10,988 (US dollars) per case of gonorrhea averted in FSWs, $685 per case of gonorrhea averted in clients, $9643 per case of chlamydia averted in FSWs, and $220 per case of chlamydia averted in clients ($1=7.8 Hong Kong dollars).


CONCLUSIONS
An outreach clinic is potentially less costly and more effective in preventing transmission of gonorrhea and chlamydia between FSWs and their clients in Hong Kong.
You
Joyce H S
JH
Centre for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. joyceyou@cuhk.edu.hk
Wong
William C W
WC
Sin
Chung Wah
CW
Woo
Jean
J
D002690:Chlamydia Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D002692:Chlamydia trachomatis; D003159:Community-Institutional Relations / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D006069:Gonorrhea / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011314:Preventive Health Services / Q000191:economics*; D011477:Sex Work / Q000706:statistics & numerical data*; D014932:Women's Health Services / Q000191:economics