Budgetary Impact of Compliance With STI Screening Guidelines in Persons Living With HIV

Abstract

Introduction: The 2015 Centers for Disease Control Sexually Transmitted Diseases Treatment Guidelines recommend annual screening of all people living with HIV (PLWH) for Neisseria gonorrhoeae, Chlamydia trachomatis, and syphilis; annual Trichomonas vaginalis screening is recommended for HIV-infected women. The study objective was to evaluate the budgetary impact of sexually transmitted infection (STI) screening. We hypothesized that recommended STI screening is costly and would not be covered in full by insurers. Methods: This cost analysis evaluates charges and reimbursement for recommended screening for the above 4 STIs. This study projects the net yield (reimbursement minus expenditures) of providing tests to eligible PLWH receiving care at an urban HIV clinic in Birmingham, AL. Four scenarios evaluated the net yield when different laboratory providers, rates of compliance, and Ryan White Program fund availability were examined. Results: The number of patients receiving care at our HIV clinic from August 2014 to August 2015 was 3163 (768 female and 2395 male patients). Annual screening for N. gonorrhoeae, C. trachomatis, syphilis, and T. vaginalis would lead to a mean net loss of $129,416, $118,304, $72,625, and $13,523, respectively. Most costly scenarios for a health system include the use of a regional laboratory (−$1,241,101) and lack of Ryan White HIV/AIDS Program funding (−$85,148). Discussion: Compliance with STI screening practices is costly. Sustainability will require critical analysis of true costs and cost-effectiveness of STI screening tests in PLWH. Providers, policy makers, and insurers each have a role in ensuring the provision of these evidence-based services to PLWH.

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

“…[46][47][48] Unfortunately, these same principles and practices are often not part and parcel of HIV clinical care. [49][50][51] Behavioral interventions have demonstrated efficacy in improving behaviors directly aimed at enhancing TasP. [52][53][54][55] Structural interventions and resource investments are now needed to bring these and other evidence-based interventions into the standard of clinical care for people receiving ART.…”

Reverse syphilis screening algorithm fails to demonstrate cost effectiveness in persons living with HIV

“…Although the reverse syphilis algorithm is more efficient and sensitive than the traditional algorithm, 6 it may lead to exorbitant costs for health systems serving uninsured and underinsured PLWH needing annual syphilis screening. 1 Alternatively, the traditional screening algorithm is cost saving under a range of scenarios.…”

“…Optimal medical care of persons living with HIV (PLWH) involves comprehensive preventive and screening services, which are costly to health systems. 1,2 Syphilis screening is recommended at least annually for PLWH, and more frequently for those at high risk for sexually transmitted infections. 3,4 Due to laboratory efficiency, the reverse syphilis screening algorithm is widely used for syphilis detection even in the absence of comparative and cost effectiveness data justifying its use.…”

“…Appropriate syphilis screening is closely monitored in clinics that rely on Ryan White Care Act "safety net" funding to support the care of PLWH, and failure to comply results in financial penalties. 1 This policy and the use of electronic clinical reminders have led to high rates of syphilis screening in our clinic and others. [7][8][9] Because our population has a high prevalence of previously-treated syphilis, many patients have a positive EIA on each annual screen, which requires subsequent confirmation with an RPR and is costly to the health system.…”