Cost-effectiveness of opt-out chlamydia testing for high-risk young women in the U.S.

Owusu-Edusei, Kwame; Hoover, Karen W.; Gift, Thomas L.

doi:10.1016/j.amepre.2016.01.007

Cited by 31Reproductive tract infections researchHealth Systems, Economic Evaluations, Quality of LifeCervical Cancer and HPV Research

Cost-effectiveness of opt-out chlamydia testing for high-risk young women in the U.S.

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Owusu-Edusei, Kwame, Hoover, Karen W., Gift, Thomas L.·2016·American Journal of Preventive Medicine

DOI 10.1016/j.amepre.2016.01.007PMC PMC6785744

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Abstract

Introduction In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective.Methods Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015.Results Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate.Conclusions The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care.

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Cost-effectiveness analyses indicate that opt-out chlamydia screening among adolescent and young adult females might substantially increase screening, be cost-saving, and identify infections among patients who do not disclose sexual behavior.
“Cost-effectiveness analyses indicate that opt-out chlamydia screening among adolescent and young adult females might substantially increase screening, be cost-saving (172), and identify infections among patients who do not disclose sexual behavior (173).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [172]

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Additional file 4 of Are intersectoral costs considered in economic evaluations of interventions relating to sexually transmitted infections (STIs)? A systematic review
Schnitzler, L., Evers, S., Jackson, L. J., Paulus, A. T. G., & Roberts, T. E. (2022) · Figshare · doi:10.6084/m9.figshare.21629169
Additional file 5 of Are intersectoral costs considered in economic evaluations of interventions relating to sexually transmitted infections (STIs)? A systematic review
Schnitzler, L., Evers, S., Jackson, L. J., Paulus, A. T. G., & Roberts, T. E. (2022) · Figshare · doi:10.6084/m9.figshare.21629172
Additional file 2 of Are intersectoral costs considered in economic evaluations of interventions relating to sexually transmitted infections (STIs)? A systematic review
Schnitzler, L., Evers, S., Jackson, L. J., Paulus, A. T. G., & Roberts, T. E. (2022) · Figshare · doi:10.6084/m9.figshare.21629163
Additional file 1 of Chlamydia-related knowledge, opinion to opportunistic testing, and practices of providers among different sexually transmitted infections related departments in hospitals in Shenzhen city, China
Weng, R., Zhang, C., Wen, L., Luo, Y., Ye, J., Wang, H., Li, J., Ning, N., Huang, J., Chen, X., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19711216
Additional file 1 of Are intersectoral costs considered in economic evaluations of interventions relating to sexually transmitted infections (STIs)? A systematic review
Schnitzler, L., Evers, S., Jackson, L. J., Paulus, A. T. G., & Roberts, T. E. (2022) · Figshare · doi:10.6084/m9.figshare.21629160
Additional file 3 of Are intersectoral costs considered in economic evaluations of interventions relating to sexually transmitted infections (STIs)? A systematic review
Schnitzler, L., Evers, S., Jackson, L. J., Paulus, A. T. G., & Roberts, T. E. (2022) · Figshare · doi:10.6084/m9.figshare.21629166
A Staff-Directed Electronic Medical Record Alert to Increase Chlamydia Screening
Wiesenfeld, H. C., Hong, J., Xu, T., Cuffe, K. M., Bernstein, K. T., Gift, T. L., & Fischer, G. S. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.15360
Self-citation

O06.5 An Exploratory Evaluation of Universal Opt-Out Chlamydia Testing During Clinical Encounters For Young Women in the United States
Owusu‐Edusei, K., Hoover, K. W., Hart-Cooper, G. D., & Gift, T. (2013) · Sexually Transmitted Infections · doi:10.1136/sextrans-2013-051184.0117
Self-citation
Chlamydien-Infektion – Kosteneffektivität einer „Opt-Out“-Teststrategie
Owusu‐Edusei, K. (2016) · Gesundheitsökonomie & Qualitätsmanagement · doi:10.1055/s-0042-116742
Self-citation
P194 Cost-effectiveness of chlamydia testing in scotland
Wallace, L. A., Looker, K. J., & Turner, K. (2015) · Sexually Transmitted Infections · doi:10.1136/sextrans-2015-052126.238
P08.38 Cost-effectiveness of chlamydia testing in scotland
Looker, K. J., Wallace, L., & Turner, K. (2015) · Sexually Transmitted Infections · doi:10.1136/sextrans-2015-052270.384
The cost effectiveness of opportunistic chlamydia screening in England
Adams, E. J., Turner, K., Edmunds, W. J., Roberts, T. E., Low, N. N., Adams, E. J., Edmunds, W. J., & Turner, K. (2007) · Sexually Transmitted Infections · doi:10.1136/sti.2006.024364 · Cited by 87 · see citing works

Authors: Owusu-Edusei, K., Hoover, K. W., & Gift, T. L.
Affiliations: Centers for Disease Control and Prevention (US)
ORCID: Owusu-Edusei, Kwame
Hoover, Karen W.
Gift, Thomas L.
Venue: American Journal of Preventive Medicine
Publisher: Elsevier BV
Published: 2016-08
Volume: 51
Issue: 2
Pages: 216-224
ISSN: 0749-3797 (ISSN-L)
DOI: 10.1016/j.amepre.2016.01.007
PMC: PMC6785744
OpenAlex: W2291188718
Cited by: 31
References: 60
Citations by year: 2026: 1 · 2024: 1 · 2023: 2 · 2022: 11 · 2021: 6 · 2020: 4 · 2019: 3 · 2018: 2 · 2017: 1
FWCI: 2.04
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: American Journal of Preventive Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (CC999999)
Topics: Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Keywords: chlamydia screening, opt-out testing, cost-effectiveness, young women, risk-based screening, sexually transmitted infections, chlamydia prevalence, health insurance coverage, health care utilization, test acceptance, incremental cost-effectiveness ratio
MeSH terms: Adolescent, Chlamydia Infections, Chlamydia trachomatis, Cost-Benefit Analysis, Female, Humans, Mass Screening, Patient Acceptance of Health Care, Risk, United States, Prevalence, Young Adult

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Cost-effectiveness of opt-out chlamydia testing for high-risk young women in the U.S.

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