title: Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S.
abstract: In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective.
  
  
  
  Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015.
  
  
  
  Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate.
  
  
  
  The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care.
authors.affiliation: Division of STD Prevention, CDC, Atlanta, Georgia. Electronic address: kowusuedusei@cdc.gov.
authors.forename: Kwame
authors.initials: K
authors.lastname: Owusu-Edusei
authors.affiliation: Division of STD Prevention, CDC, Atlanta, Georgia.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Hoover
authors.affiliation: Division of STD Prevention, CDC, Atlanta, Georgia.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gift
mesh_terms: D000293:Adolescent; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012306:Risk; D014481:United States; D055815:Young Adult