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

2. Background
Cost of screening outside Chlamydia Screening Guidelines presented June 2010—data for 3 states,
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

3. Methods for Developing the Cost Analysis Tool
Key informant interviews conducted in 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

4. 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

5. 2010: Percent of CT Tests Done Outside Guidelines
Outside guidelines: 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%)

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

7. 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

8. 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

9. 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 $ ,029, Number of tests done outside screening criteria 2214
Testing Kit Costs $ ,545.67
Exam Costs $ ,711.48
Laboratory Costs $ ,740.71
TOTAL COST OF TESTS $ ,997.86
ESTIMATED AVERAGE COST PER TEST DONE OUTSIDE SCREENING $ COST OF TESTS OUTSIDE SCREENING CRITERIA   PERCENT OF BUDGET SPENT ON TESTS OUTSIDE SCREENING CRITERIA 2%

10. 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

11. Questions?