# Presentation: 681806

## A Cost-Effectiveness Evaluation of the Sexually Transmitted Disease (STD) Prevention Program at the Hampden County Correctional Center, Massachusetts

- Gift T1, Conklin T2, Lincoln T2, Miller A3, Tuthill R3, Whelan M4, Irwin K1
- 1Centers for Disease Control and Prevention, Atlanta, GA; 2Hampden County Correctional Center, Ludlow, MA; 3University of Massachusetts-Amherst, Amherst, MA; 4 Massachusetts Department of Public Health

## Background

- Inmates in correctional institutions are an important population for STD prevention
- Inmates’ sex partners also frequently have high STD rates
- STD testing and treatment programs must often compete with other correctional healthcare programs
- Cost-effectiveness evaluation is a tool that can:
- guide resource allocation decisions
- quantify the impact of correctional STD testing programs on community health

## Background-2

- Hampden County Correctional Center (HCCC) STD Program:
- Intake screening for chlamydia
- Leukocyte esterase test (LET)
- Nucleic acid amplification test (NAAT; LCx®, Abbott Laboratories)
- Gonorrhea testing
- Performed if symptoms, risk factors, or LET results warrant
- Nucleic acid probe test (probe; Gen-Probe PACE® 2 GC; Gen-Probe, Inc.)

## Objective

- Determine the cost and cost-effectiveness of universal vs. targeted screening for chlamydia and gonorrhea in male inmates at intake

## Methods-Data Sources

- Test Data
- Test results provided by Massachusetts Dept. of Public Health (MDPH)
- Test performance parameters:
- NAAT for chlamydia, probe for gonorrhea: literature estimates
- LET: MDPH
- Costs
- Labor costs: time-motion studies at HCCC
- Partner services costs: literature estimates
- Testing, treatment, overhead, and supply costs: HCCC
- Sequelae costs (epididymitis, PID): literature estimates

## Methods-Data Sources (Cont.)

- Partner Data
- Estimates of partner data provided by MDPH and HCCC
- Data collection is proceeding
- Literature estimates used for costs
- Inmate Data
- Demographics, symptoms, risk factors collected by HCCC and reported by MDPH for first quarter, 2001

## Methods-Program Alternatives

- Four program alternatives were modeled:
- _1) Present Practice_
- Screen all males for chlamydia with LET and NAAT
- Offer probe test for gonorrhea if:
- Inmate is symptomatic, discloses risk factors, or LET is positive
- _2) Age-based testing (Under 25 years of age) _
- Same as present practice for inmates < 25 years of age
- symptom-based testing for inmates over the age cutoff
- _3) Age-based testing (Under 30 years of age)_
- Same as (2) except upper age cutoff is 30
- _4) Symptom-based testing only_
- Only test inmates (all ages) who present with symptoms for chlamydia and gonorrhea

## Descriptive Statistics

## Male Inmates and Male Inmates with Chlamydia: Age Breakdowns

-  30

- < 25

- 25-29

-  30

- < 25

- 25-29

- Male Inmates (n = 394)

- Male Inmates with Chlamydia (n = 24)

## Results

- Data shown are for 1000 male inmates with the prevalences shown in the descriptive statistics table
- All costs in 2001 dollars

## Results

- *Eliminating the LET and relying only on the NAAT would reduce program costs by $2520.  The cases of CT/GC treated would be 42.2

## Results

- *Eliminating the LET and relying only on the NAAT would reduce healthcare system cost by $2520. The cases of PID averted would be 1.99

## Limitations

- Some data taken from literature:
- Partner services cost and effectiveness
- Cases of PID in partners
- Cases of gonorrhea in male inmates
- Age-based prevalence of chlamydia and gonorrhea may not be constant across time
- Chlamydia program benefits not included:
- reduction in HIV transmission due to treated chlamydial infections
- increased HIV counseling and testing opportunities resulting from STD diagnoses

## Conclusions

- Chlamydia and gonorrhea screening:
- can detect and treat a high proportion of both infections among male inmates
- is more effective than restricting testing to symptomatic inmates only
- may lead to the detection and treatment of PID in their female sex partners
- Age-based screening has the potential to reduce program costs with little loss in effectiveness.