A Cost-Effectiveness Evaluation of the Sexually Transmitted Disease (STD) Prevention Program at the Hampden County Correctional Center, Massachusetts Gift T 1, Conklin T 2, Lincoln T 2, Miller A 3, Tuthill R 3, Whelan M 4, Irwin K 1 1 Centers for Disease Control and Prevention, Atlanta, GA; 2 Hampden County Correctional Center, Ludlow, MA; 3 University of Massachusetts-Amherst, Amherst, MA; 4 Massachusetts Department of Public Health

Background Inmates in correctional institutions are an important population for STD prevention –Inmates’ sex partners also frequently have high STD rates STD testing and treatment programs must often compete with other correctional healthcare programs Cost-effectiveness evaluation is a tool that can: –guide resource allocation decisions –quantify the impact of correctional STD testing programs on community health

Background-2 Hampden County Correctional Center (HCCC) STD Program: –Intake screening for chlamydia Leukocyte esterase test (LET) Nucleic acid amplification test (NAAT; LCx ®, Abbott Laboratories) –Gonorrhea testing Performed if symptoms, risk factors, or LET results warrant Nucleic acid probe test (probe; Gen-Probe PACE ® 2 GC; Gen- Probe, Inc.)

Objective Determine the cost and cost-effectiveness of universal vs. targeted screening for chlamydia and gonorrhea in male inmates at intake

Methods-Data Sources Test Data –Test results provided by Massachusetts Dept. of Public Health (MDPH) –Test performance parameters: NAAT for chlamydia, probe for gonorrhea: literature estimates LET: MDPH Costs –Labor costs: time-motion studies at HCCC Partner services costs: literature estimates –Testing, treatment, overhead, and supply costs: HCCC –Sequelae costs (epididymitis, PID): literature estimates

Methods-Data Sources (Cont.) Partner Data –Estimates of partner data provided by MDPH and HCCC Data collection is proceeding Literature estimates used for costs Inmate Data –Demographics, symptoms, risk factors collected by HCCC and reported by MDPH for first quarter, 2001

Methods-Program Alternatives Four program alternatives were modeled: 1) Present Practice –Screen all males for chlamydia with LET and NAAT –Offer probe test for gonorrhea if: –Inmate is symptomatic, discloses risk factors, or LET is positive 2) Age-based testing (Under 25 years of age) –Same as present practice for inmates < 25 years of age –symptom-based testing for inmates over the age cutoff 3) Age-based testing (Under 30 years of age) –Same as (2) except upper age cutoff is 30 4) Symptom-based testing only –Only test inmates (all ages) who present with symptoms for chlamydia and gonorrhea

Descriptive Statistics

 30 <  30 < Male Inmates (n = 394) Male Inmates with Chlamydia (n = 24) Male Inmates and Male Inmates with Chlamydia: Age Breakdowns

Results Data shown are for 1000 male inmates with the prevalences shown in the descriptive statistics table All costs in 2001 dollars

Results * Eliminating the LET and relying only on the NAAT would reduce program costs by $2520. The cases of CT/GC treated would be 42.2

Results * Eliminating the LET and relying only on the NAAT would reduce healthcare system cost by $2520. The cases of PID averted would be 1.99

Limitations Some data taken from literature: –Partner services cost and effectiveness –Cases of PID in partners –Cases of gonorrhea in male inmates Age-based prevalence of chlamydia and gonorrhea may not be constant across time Chlamydia program benefits not included: –reduction in HIV transmission due to treated chlamydial infections –increased HIV counseling and testing opportunities resulting from STD diagnoses

Conclusions Chlamydia and gonorrhea screening: –can detect and treat a high proportion of both infections among male inmates –is more effective than restricting testing to symptomatic inmates only –may lead to the detection and treatment of PID in their female sex partners Age-based screening has the potential to reduce program costs with little loss in effectiveness.