Cost-effectiveness of screening strategies for gonorrhea among females in private sector care

Kyle T. Bernstein, Supriya D. Mehta, Anne Marie Rompalo, Emily J. Erbelding

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)813-821
Number of pages9
JournalObstetrics and Gynecology
Volume107
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

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Private Sector
Gonorrhea
Cost-Benefit Analysis
Costs and Cost Analysis
Infection
Baltimore
Decision Support Techniques
Sexual Partners
Sexually Transmitted Diseases
Nucleic Acids
Observation
Outcome Assessment (Health Care)
Urine
Sensitivity and Specificity
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Cost-effectiveness of screening strategies for gonorrhea among females in private sector care. / Bernstein, Kyle T.; Mehta, Supriya D.; Rompalo, Anne Marie; Erbelding, Emily J.

In: Obstetrics and Gynecology, Vol. 107, No. 4, 04.2006, p. 813-821.

Research output: Contribution to journalArticle

Bernstein, Kyle T. ; Mehta, Supriya D. ; Rompalo, Anne Marie ; Erbelding, Emily J. / Cost-effectiveness of screening strategies for gonorrhea among females in private sector care. In: Obstetrics and Gynecology. 2006 ; Vol. 107, No. 4. pp. 813-821.
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