Targeted and universally offered screening are cost-effective compared with no screening for identifying sexually transmitted infections (STIs) in adolescents and young adults who use the emergency department (ED) for acute care (JAMA Pediatr. 2020;e203571. doi:10.1001/jamapediatrics.2020.3571).
“Adolescents and young adults compose almost 50% of all diagnosed [STI] cases annually in the US. Given that these individuals frequently access health care through the [ED], the ED could be a strategic venue for examining the identification and treatment of STIs,” wrote Mark Eckman, MD, MS, Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati Medical Center, Ohio, and colleagues.
This economic evaluation aimed to evaluate the cost-effectiveness of screening strategies for chlamydia and gonorrhea in these patients and is part of an ongoing larger multicenter clinical trial.
A decision analytic model was developed to simulate outcomes associated with 3 strategies for screening and testing chlamydial and gonococcal infections in individuals aged 15 to 21 years. The screening strategies were no screening, targeted screening, and universally offered screening.
Outcomes from the screenings included cost and the detection and successful treatment of STIs. The incremental cost-effectiveness ratio (ICER) was calculated for each method.
Targeted screening resulted in the detection and successful treatment of 26.4% STI cases at a cost of $313,063, and universally offered screening identified and treated 31.1% STI cases at a cost of $515,503. The ICER for targeted screening versus no screening was $6444, and the ICER for universally offered screening versus targeted screening was $12,139.
“This economic evaluation found that targeted screening and universally offered screening compared with no screening appeared to be cost-effective strategies for identifying and treating chlamydial and gonococcal infections in adolescents and young adults who used the ED for acute care,” concluded Dr Eckman and colleagues.
“Universally offered screening was associated with detecting and successfully treating a higher proportion of STIs in this population,” they added.—Lisa Kuhns
