Cost-effectiveness of screening strategies for Gonorrhea among females in private sector care.
OBJECTIVE
To identify the optimal screening algorithm for gonorrhea infection among females in private sector care, using cost-effectiveness analysis.


METHODS
We compared 6 strategies using decision analysis for urine nucleic acid amplification testing for gonorrhea testing in a theoretical cohort of 10,000 females aged 15-35 years: 1) screen women aged younger than 25 years; 2) screen women aged younger than 30 years; 3) screen women aged younger than 25 years who report any risk (pregnant, drug use, new sexual partner < 30 days); 4) screen women aged younger than 30 years who report any risk; 5) screen women aged younger than 25 years or those who report any risk; and 6) screen women aged younger than 30 years or those who report any risk. Infection prevalence and sensitivity and specificity were by direct observation from a retrospective cohort of females attending the Baltimore City Sexually Transmitted Disease Clinics between 1999 and 2002. The main outcome measures were untreated gonorrhea cases and their sequelae in women, transmission to a male partner, congenital outcomes, and cost to prevent a case.


RESULTS
Prevalence of gonorrhea was 3.0%. Not screening would result in 300 untreated cases. Not screening was cost-saving over all screening strategies. Strategy 6 resulted in the fewest cases of untreated infection (82), although Strategy 3 was the most cost-effective of the screening strategies. Univariate sensitivity analysis identified a threshold of 4.75% gonorrhea prevalence, more than which Strategy 3 became cost-saving over not screening.


CONCLUSIONS
Screening is recommended for females aged younger than 25 years with specific risks in populations with a gonorrhea prevalence of 4.75% or greater.


METHODS
II-2.
Department of Emergency Medicine, New York University School of Medicine, New York 10016, USA. kyle.bernstein@med.nyu.edu
Kyle T
KT
Bernstein
Supriya D
SD
Mehta
Anne M
AM
Rompalo
Emily J
EJ
Erbelding
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D015995:Prevalence; D011331:Private Practice / Q000191:economics; D017149:Private Sector / Q000191:economics*; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control