Cost of Screening Outside of IPP Chlamydia Screening Guidelines Andee Krasner, MPH Region I IPP Advisory Board Meeting June 6th, 2011

Background Cost of screening outside Chlamydia Screening Guidelines presented June 2010—data for 3 states, 2009-2010 Goal: develop tool for use by STD Directors to determine annual cost of screening outside guidelines ME piloted tool October 2010, copies distributed at November 2010 meeting Programs used tool for first time April 2011

Methods for Developing the Cost Analysis Tool Key informant interviews conducted in 2009 for original cost analysis Used to determine all steps of testing, end-to- end State IPP testing programs vary – the tool had to be flexible, but still collect same basic data across programs from ordering a test to reporting the test outcome for a client flexible to reflect differences in ordering test, collecting specimen, processing it and reporting it

Methods for Collecting Data Some programs have data from their budgets; others estimate. Asked states to indicate how much of data was estimated. How reliable are the data? More than half of data were estimated

2010: Percent of CT Tests Done Outside Guidelines Outside guidelines: 25-26 or older; no risk factors and no clinical signs of infection 30,722 tests done in women 2,214 outside guidelines Region I Average: 6% outside guidelines (Range: 1-19%) Data from Region I Prevalence Monitoring Data System Average (6%)

Positivity Rate of Tests Outside Guidelines Average CT positivity rate of women screened outside guidelines, across six states? 2% (Range: 0-2.93%) Below recommended 3% rate to be cost effective 2.35% if not weighted equally across states.

Average Cost of CT Test Paid for by IPP Average cost of CT test done outside IPP screening guidelines: $11.29 No one uses IPP budget to pay for all costs Purchase Test Distribute Specimen collection units -Collect specimen and send to Lab -Communicate results to client Lab processes specimen and communicates results to clinic Data Management Create swirly diagram indicating test process; label with avg cost; remove and speak last bullet point Average cost of CT test done outside IPP screening guidelines: $11.29 Costs may include: tests, distribution, specimen collection, client communication, courier, lab processing, data management No one uses IPP budget to pay for all costs

Real Costs of Testing Analysis includes only IPP test costs, not the full cost: Only one state paid for some medical services as part of IPP funding Cost for specimen collection and client communication was estimated to be far greater than what was paid to clinics to provide the service Not all lab processing costs accounted for

Impact on IPP Budget Average percent of budget spent on tests outside screening guidelines: 2% (range 1%- 17%) Impact of testing outside screening guidelines goes beyond IPP budget IPP Budget for Study Period $ 1,029,271.00 Number of tests done outside screening criteria 2214 Testing Kit Costs $ 13,545.67 Exam Costs $ 8,711.48 Laboratory Costs $ 2,740.71 TOTAL COST OF TESTS $ 24,997.86 ESTIMATED AVERAGE COST PER TEST DONE OUTSIDE SCREENING $ 11.29 COST OF TESTS OUTSIDE SCREENING CRITERIA   PERCENT OF BUDGET SPENT ON TESTS OUTSIDE SCREENING CRITERIA 2%

Conclusions CT positivity doesn’t support screening outside guidelines Money could be used to target populations with higher positivity True cost of screening outside CT screening guidelines goes beyond IPP paid tests, and impacts clinic and lab costs Variability in how states pay for testing makes estimating average cost of test difficult Data not reliable—more than half estimated

Questions?