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Cost Effectiveness of Universal Screening for Chlamydia
and Gonorrhea in US Jails.
Journal of Urban Health 2004;81:453-471.
Kraut-Becher JR, Gift TL, Haddix AC, Irwin KL, Greifinger RB.
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
urine-based 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 cost-effectiveness 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.
