# Presentation: 792311

## The Cost-Effectiveness of Screening Asymptomatic Men for Chlamydia to Prevent Pelvic Inflammatory Disease (PID) in Women

- T Gift1, EF Dunne1, J Chapin1, C Kent2, C Gaydos3, JM Marrazzo4,
- J Ellen3,C Rietmeijer5, J Schillinger1, LE Markowitz1
- 1Centers for Disease Control and Prevention, Atlanta, GA
- 2San Francisco Department of Public Health, San Francisco, CA
- 3Johns Hopkins University School of Medicine, Baltimore, MD
- 4University of Washington School of Medicine, Seattle, WA
- 5Denver Public Health, Denver, CO

## Background

- Data from demo project and longitudinal study:
- prevalence and re-infection
- partners (pre-screening and follow-up)
- symptoms
- cost of screening activities, by venue
- Data from literature:
- sequelae and sequelae costs
- STD visit costs
- Data used in female screening comparison model
- Schillinger, et al. Sex Transm Dis 30:49-56, 2003, and others

## Model Construction & Assumptions

- Index male is screened and tests positive for CT

## Model, Continued

- Male has recent partner(s), who may be infected

## Model, Continued

- Average number of recent partners: 1.67
- 48% of infected males’ partners infected
- 16% of infected partners seek treatment if not notified by DIS

## Model, Continued

- Male may have partners during the follow-up period (4 months)

## Model, Continued

- Average number of partners during follow-up: 1.2
- Male may infect them if:
- he is re-infected (12%)
- his original infection is not treated (15%)
- If women infected, they are assumed to seek treatment on their own at the same rate as past partners (16%)

## Model, Continued

- We assumed male is screened opportunistically (cheaply)
- Cost per index male for testing: $14.37
- Cost of treatment: $22.50
- Prevalence of CT among men screened = 6.0%
- based on 6.6% positivity

## Model, Continued-Screening Women

- convenience-based screening
- same re-infection rate as with men (12%)
- patient referral for partners (no DIS field work)
- 25% of asymptomatic partners seek care if referred

## Results for Men*

| Program alternative | Program cost for 1000 men† | Cases of PID per 1000 men‡ |  |
| --- | --- | --- | --- |
| No screening |   2,070 | 29.4 |  |
| Screening /  no PN | 18,040 | 26.9 |  |
| Screening / PN | 20,030 | 25.6 |  |

- *At baseline prevalence of 6.0%
- †Costs in 2001 US dollars
- ‡Cases of PID in men’s female partners

## Results for Men*

| Program alternative | Program cost for 1000 men† | Sequelae cost averted‡ |  |
| --- | --- | --- | --- |
| No screening |   2,070 |  |  |
| Screening /  no PN | 18,040 | 3,300 |  |
| Screening / PN | 20,030 | 4,940 |  |

- *At baseline prevalence of 6.0%
- †Costs in 2001 US dollars
- ‡Compared to no screening; PID cost per case = $1303
- Two costs used for PID: low = $1303, high = $3071

## Results for Men*

| Program alternative | Program cost for 1000 men† | Sequelae cost averted‡ | Net cost of program§ |
| --- | --- | --- | --- |
| No screening |   2,070 |  | 2,070 |
| Screening /  no PN | 18,040 | 3,300 | 14,740 |
| Screening / PN | 20,030 | 4,940 | 15,090 |

- *At baseline prevalence of 6.0%
- †Costs in 2001 US dollars
- ‡Compared to no screening; PID cost per case = $1303
- §Net cost of program = program cost – sequelae cost averted

## Results for Women*

| Program alternative | Program cost for 1000 women† | Cases of PID per 1000 women | Net program cost‡ |
| --- | --- | --- | --- |
| No screening |   1,110 | 5.2 |  |
| Screening / No PN | 16,420 | 3.6 | 14,330 |

- *At baseline prevalence of 2.0%
- †Costs in 2001 US dollars
- ‡ PID cost per case = $1303

## $14.99

- *Cost per case of PID = $1303

- Screening women at a prevalence of 1% costs the same (in terms of net program costs) as screening men at a prevalence of 6%, but averts fewer cases of PID

- 3.8 cases of PID averted

- 0.8 cases of PID averted

## $12.84

- *Cost per case of PID = $1303

- Screening women at a prevalence of 4.6% is as effective (in terms of cases of PID prevented) as screening men at a prevalence of 6%

- $14.99

## $8.39

- *Cost per case of PID = **$3071**

- $6.34

-  3.6%

- 3.8 cases of PID averted

- 2.9 cases of PID averted

## Limitations

- Results would differ with different partnership structures
- value of treating men declines as partner numbers decline
- Partner management options for men’s partners limited to PN vs. no PN
- other options (partner-delivered therapy) may yield different results
- Results would differ with more-costly non-opportunistic screening

## Conclusions

- Screening men can benefit women by:
- reducing the number of infectious men
- leading to the treatment of asymptomatic women through PN
- Screening men can be cost-effective:
- if the prevalence among unscreened women who can potentially be screened is lower than the prevalence among men who can be screened, all else equal
- e.g., men in detention settings vs. women > 25 or > 30 in family planning settings