Kenneth J. Smith et al. and beneﬁts gained [12]. For example, Hu et al. [4] found that annual chlamydia screening cost 2350 per quality ad- justed life year gained compared to no screening and thus would be considered very cost-eﬀective compared to other health care interventions. In our analysis, where equal infec- tion rates are seen between intervention groups, the cost per health beneﬁt gained depends on the beneﬁts of greater test- ing frequency for infected women and their partners. Unfor- tunately, these beneﬁts cannot be estimated based on present data, a limitation of our analysis. 4. CONCLUSIONS A home testing intervention for chlamydia and gonorrhea, while increasing testing rates, has the potential to be cost sav- ing when the direct and indirect costs of avoided clinic visits are considered. The cost equation depends in large part on whether changes in clinic testing frequency and STD detec- tion occur as a result. Home testing eﬀects on clinic testing frequency in other populations and on individual and pop- ulation health in localities with more limited health services require further research. REFERENCES [1] R. L. Cook, L. Ostergaard, S. L. Hillier, et al., “Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial,” Sexually Transmitted Infections, vol. 83, no. 4, pp. 286–291, 2007. [2] L. Ostergaard, B. Andersen, F. Olesen, and J. K. Moller, “Eﬃ- cacy of home sampling for screening of Chlamydia trachomatis randomised study,” British Medical Journal, vol. 317, no. 7150, pp. 26–27, 1998. [3] L. Ostergaard, B. Andersen, J. K. Moller, and F. Olesen, “Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study,” Clinical Infectious Diseases, vol. 31, no. 4, pp. 951–957, 2000. [4] D. Hu, E. W. Hook III, and S. J. Goldie, “Screening for Chlamy- dia trachomatis in women 15 to 29 years of age: a cost- eﬀectiveness analysis,” Annals of Internal Medicine, vol. 141, no. 7, pp. 501–503, 2004. [5] D. Scholes, A. Stergachis, F. E. Heidrich, H. Andrilla, K. K. Holmes, and W. E. Stamm, “Prevention of pelvic inﬂamma- tory disease by screening for cervical chlamydial infection,” The New England Journal of Medicine, vol. 334, no. 21, pp. 1362–1366, 1996. [6] N. Calonge, D. B. Petitti, J. D. Allan, et al., “Screening for gonorrhea: recommendation statement,” Annals of Family Medicine, vol. 3, no. 3, pp. 263–267, 2005. [7] J. E. Aledort, E. W. Hook III, M. C. Weinstein, and S. J. Goldie, “The cost eﬀectiveness of gonorrhea screening in urban emer- gency departments,” Sexually Transmitted Diseases, vol. 32, no. 7, pp. 425–436, 2005. [8] R. L. Cook, H. C. Wiesenfeld, M. R. Ashton, M. A. Krohn, T. Zamborsky, and S. H. Scholle, “Barriers to screening sexually active adolescent women for Chlamydia a survey of primary care physicians,” Journal of Adolescent Health, vol. 28, no. 3, pp. 204–210, 2001. [9] W. C. Levine, L. W. Dicker, O. Devine, and D. J. Mosure, “In- direct estimation of Chlamydia screening coverage using pub- lic health surveillance data,” American Journal of Epidemiology, vol. 160, no. 1, pp. 91–96, 2004. 5 [10] M. R. Gold, J. E. Siegel, L. B. Russell, and M. C. Weinstein, Eds., Cost-Eﬀectiveness in Health and Medicine, Oxford University Press, New York, NY, USA, 1996. [11] United States Bureau of Labor Statistics, “Hourly wage of pro- duction workers,” 2005, http://www.bls.gov. [12] T. O. Tengs, M. E. Adams, J. S. Pliskin, et al., “Five-hundred life-saving interventions and their cost-eﬀectiveness,” Risk Analysis, vol. 15, no. 3, pp. 369–390, 1995.