Cost-Effectiveness of Universal Screening for Chlamydia and Gonorrhea in US Jails

Abstract

Universal screening for the sexually transmitted diseases (STDs) of chlamydia and gonorrhea on intake in jails has been proposed as the most effective strategy to decrease morbidity in inmates and to reduce transmission risk in communities after release. Most inmates come from a population that is at elevated risk for STDs and has limited access to health care. However, limited resources and competing priorities force decision makers to consider the cost of screening programs in comparison to other needs. The costs and cost-effectiveness of universal screening in correctional settings have not been documented. We estimated the incremental cost-effectiveness of universal urinebased screening for chlamydia and gonorrhea among inmates on intake in US jails compared to the commonly used practice of presumptive treatment of symptomatic inmates without laboratory testing. Decision analysis models were developed to estimate the costeffectiveness of screening alternatives and were applied to hypothetical cohorts of male and female inmates. For women, universal screening for chlamydia only was cost-saving to the health care system, averting more health care costs than were incurred in screening and treatment. However, for men universal chlamydia screening cost $4,856 more per case treated than presumptive treatment. Universal screening for both chlamydia and gonorrhea infection cost the health care system $3,690 more per case of pelvic inflammatory disease averted for women and $650 more per case of infection treated for men compared to universal screening for chlamydia only. Jails with a high prevalence of chlamydia and gonorrhea represent an operationally feasible and cost-effective setting to universally test and treat women at high risk for STDs and with limited access to care elsewhere.

A Cost-Effectiveness Evaluation of a Jail-Based Chlamydia Screening Program for Men and Its Impact on Their Partners in the Community

“…8 Universal screening for chlamydia has been shown to be costsaving for female inmates in whom the prevalence is 8% or higher, but not for male inmates. 9 Cost-effectiveness studies in other settings have had similar conclusions. 10 This is because the sequelae of untreated or inadequately treated chlamydial infection in women-primarily pelvic inflammatory disease (PID) and its sequelae of chronic pelvic pain, infertility, and increased risk of ectopic pregnancy-are more common and costly than the most common sequelae of untreated chlamydial infection in men, epididymitis.…”

“…9,46 Although the screening program itself is not cost-saving, the partner notification program provides a link between disease identified in the incarcerated population and disease in the surrounding community and provides a way for the healthcare services provided to inmates to benefit individuals in the nonincarcerated population who may also have limited access to care. In the case of HCCC, an institution that has decided to screen male inmates for chlamydia, partner notification is a cost-effective adjunct.…”

Prevalence Trends in Chlamydial Infections Among Young Women Entering the National Job Training Program, 1998–2004

“…This persistently high prevalence makes this advantaged population a cost-effective venue for chlamydia screening. 22,23 The persistent high prevalence and the less pronounced decline seen in recent years may be due to relatively low chlamydia screening coverage for adolescent Program, 1998Program, -2004 women and limited screening in men. Screening and treatment of chlamydia in men have the potential to reduce the chlamydia reservoir in the community and reduce the incidence and prevalence of recurrent infection in women.…”

Enhanced chlamydia surveillance in New South Wales (Australia) prisons, 2005‐2007

“…In California, United States chlamydia prevalence among men and women prisoners aged 18Á25 years averaged 9.4%, compared with a prevalence of 2.2% among males and females aged 14Á39 years in the general community (Bernstein et al, 2006;Datta et al, 2007). Limited cost-effectiveness studies in American prisons suggest that age-based chlamydia screening of young prisoners on reception may be regarded as a cost-effective public health intervention (Gift et al, 2006;Krauut-Becher, Gift, & Haddix, 2004).…”