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Health services and policy oral session 3—partner notification
O5-S3.03 Incremental cost-effectiveness of introducing partner notification with selective screening for STD control in Louisiana
  1. M Rahman1,
  2. M Khan2,
  3. L Longfellow1
  1. 1Louisiana Office of Public Health, Metairie, USA
  2. 2Tulane University, New Orleans, USA

Abstract

Background Selective screening and partner notification are the two strategies used by the STD control programs in USA to reduce and or eliminate syphilis. So far no study has assessed the cost and effectiveness of either approach at the state level. The objective of this study is to assess the incremental cost effectiveness (ICE) of adding partner notification with selective screening (SS) in detecting early syphilis and to measure ICE of intensity of partner notification in Louisiana.

Method The cost effectiveness analysis (CEA) was done from the point of view of health care delivery. Micro costing approach was used in cost analysis and the CEA was performed by using the recurrent direct costs associated with detecting syphilis by SS and by SS with partner notification see Abstract O5-S3.03 figure 1. For ICE of intensity of partner notification, cost was calculated for every attempt made to contact a partner and effectiveness was calculated by the number of partners identified as well as the number of cases identified through partner notification.

Abstract O5-S3.03 Figure 1

Steps involved in syphilis case detection by partner notification and selective screening and cost associated in each method. Partner notification: A- cost for phlebotomy B- cost of tests C- cost for surveillance D- cost for case management including travel. Selective screening: 1- cost for phlebotomy, 2- cost of tests, 3- cost to contact infected patients including phone call and letter or field visit related supplies and travel.

Results The estimates of direct costs associated with SS was $6.4 million for 1005 early syphilis cases detected and $6.7 million for SS with partner notification. Partner notification detected additional 279 early syphilis cases with an additional cost of $314 498. Incremental cost of adding partner notification with SS was $2808 per primary and secondary syphilis case, $1883 per early latent syphilis case, and $1127 per early syphilis case identified. ICE of identifying partner showed a decline with the increase in number of attempts but the ICE values of case detection through partner notification did not show any systematic pattern.

Conclusion This study demonstrates that adding partner notification with SS is more CE in syphilis detection in Louisiana compared to case detection by SS alone. In terms of intensity of partner notification, it was found that increasing the number of attempts to contact the partners remained cost effective but due to variability in the number of attempts to contact cases, it was not possible to determine the optimal number of attempts.

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