Tao G, Abban B, Gift T, Irwin K; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1514.
CDC, Division of STD, 1600 Clifton RD, MS-E80, Atlanta, GA 30333 Tel. 404.639.8180 Fax 404.639.8607
RESEARCH OBJECTIVE: Disparities in the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection among different populations and the many available screening tests and treatments, make it complex to select the optimal CT or NG screening and treatment strategy for asymptomatic women. The goal of this study is to apply a binary programming model that would determine the optimal screening and treatment strategy for CT and NG in a public-sector family planning facility. STUDY DESIGN: Several scenarios were considered for CT and NG screening and treatments, including scenarios in which patients who tested positive and were treated for one pathogen were also presumptively treated for the other pathogen. We developed a binary programming model to define the optimal strategy in which the combination of infections screened for, age groups screened, tests, and treatments administered would maximize cost-savings. A cost-saving program was classified as one in which the cost of treating sequelae of CT and NG infection that would be averted by screening and treatment was greater than the cost of screening and treating all eligible women for CT and NG in the clinic. Data used in the model were from the published literature but any local data can be used. POPULATION STUDIED: asymptomatic women for sexually transmitted diseases aged > 15 years who visited public-sector family planning clinics PRINCIPAL FINDINGS: The optimal screening and treatment strategy for CT and NG varied with CT prevalence, NG prevalence, and CT-NG co-infection rates and program budget. CT screening is cost-saving when CT prevalence exceeds 3.4%, while NG screening is cost-saving when NG prevalence exceeds 2.9%. At CT prevalence of 5.0%, NG prevalence of 1.0%, and no budget constraint, the optimal cost-saving strategy was screening and treating all eligible women for CT, and presumptively treating those with positive CT tests for NG. Sensitivity analysis showed the optimal strategy was strongly influenced by test cost but not treatment cost. CONCLUSIONS: Optimal strategies for CT and NG were highly dependent on CT and NG prevalence and CT-NG co-infection rates, suggesting that screening and treatment should be targeted to populations at high risk for these infections. In addition, the result that the optimal strategy was strongly influenced by test cost but not treatment cost suggested that a more optimal screening and treatment program can be achieved by negotiating lower test costs. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: This binary programming model provides a flexible, customizable tool for programs to identify the screening and treatment strategy for CT and NG that maximizes use of prevention resources. It can be applied to other preventive and therapeutic services.
Publication Types:
Keywords:
- Ambulatory Care Facilities
- Chlamydia Infections
- Chlamydia trachomatis
- Family Planning Services
- Female
- Gonorrhea
- Health Care Costs
- Health Resources
- Humans
- Infection
- Male
- Mass Screening
- Neisseria gonorrhoeae
- Prevalence
- Sensitivity and Specificity
- Sexually Transmitted Diseases
- diagnosis
- economics
- hsrmtgs
UI: 103624548
From Meeting Abstracts