Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia.
OBJECTIVE
Commercial sex is licensed in Victoria, Australia such that sex workers are required to have regular tests for sexually transmitted infections (STIs). However, the incidence and prevalence of STIs in sex workers are very low, especially since there is almost universal condom use at work. We aimed to conduct a cost-effectiveness analysis of the financial cost of the testing policy versus the health benefits of averting the transmission of HIV, syphilis, chlamydia and gonorrhoea to clients.


METHODS
We developed a simple mathematical transmission model, informed by conservative parameter estimates from all available data, linked to a cost-effectiveness analysis.


RESULTS
We estimated that under current testing rates, it costs over $A90,000 in screening costs for every chlamydia infection averted (and $A600,000 in screening costs for each quality-adjusted life year (QALY) saved) and over $A4,000,000 for every HIV infection averted ($A10,000,000 in screening costs for each QALY saved). At an assumed willingness to pay of $A50,000 per QALY gained, HIV testing should not be conducted less than approximately every 40 weeks and chlamydia testing approximately once per year; in comparison, current requirements are testing every 12 weeks for HIV and every 4 weeks for chlamydia.


CONCLUSIONS
Mandatory screening of female sex workers at current testing frequencies is not cost-effective for the prevention of disease in their male clients. The current testing rate required of sex workers in Victoria is excessive. Screening intervals for sex workers should be based on local STI epidemiology and not locked by legislation.
National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia. Dwilson@nchecr.unsw.edu.au
David P
DP
Wilson
Kelly-Jean
KJ
Heymer
Jonathan
J
Anderson
Jody
J
O'Connor
Christine
C
Harcourt
Basil
B
Donovan
D017280:Condoms / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D013997:Time Factors; D014739:Victoria