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Obstetrics & Gynecology 2006;107:813-821
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Cost-Effectiveness of Screening Strategies for Gonorrhea Among Females in Private Sector Care

Kyle T. Bernstein, PhD, ScM1,2, Supriya D. Mehta, PhD, MHS3, Anne M. Rompalo, MD, ScM4 and Emily J. Erbelding, MD, MPH2,4

From the 1Department of Emergency Medicine, New York University School of Medicine, New York, New York; 2Sexually Transmitted Disease Program, Division of Health Promotion and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland; 3Department of Emergency Medicine, Boston University, School of Medicine, Boston, Massachusetts; and 4Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland.

OBJECTIVE: To identify the optimal screening algorithm for gonorrhea infection among females in private sector care, using cost-effectiveness analysis.

METHODS: We compared 6 strategies using decision analysis for urine nucleic acid amplification testing for gonorrhea testing in a theoretical cohort of 10,000 females aged 15–35 years: 1) screen women aged younger than 25 years; 2) screen women aged younger than 30 years; 3) screen women aged younger than 25 years who report any risk (pregnant, drug use, new sexual partner < 30 days); 4) screen women aged younger than 30 years who report any risk; 5) screen women aged younger than 25 years or those who report any risk; and 6) screen women aged younger than 30 years or those who report any risk. Infection prevalence and sensitivity and specificity were by direct observation from a retrospective cohort of females attending the Baltimore City Sexually Transmitted Disease Clinics between 1999 and 2002. The main outcome measures were untreated gonorrhea cases and their sequelae in women, transmission to a male partner, congenital outcomes, and cost to prevent a case.

RESULTS: Prevalence of gonorrhea was 3.0%. Not screening would result in 300 untreated cases. Not screening was cost-saving over all screening strategies. Strategy 6 resulted in the fewest cases of untreated infection (82), although Strategy 3 was the most cost-effective of the screening strategies. Univariate sensitivity analysis identified a threshold of 4.75% gonorrhea prevalence, more than which Strategy 3 became cost-saving over not screening.

CONCLUSION: Screening is recommended for females aged younger than 25 years with specific risks in populations with a gonorrhea prevalence of 4.75% or greater.

LEVEL OF EVIDENCE: II-2






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