Preventing sexually transmitted infections among incarcerated men who have sex with men: a cost-effectiveness analysis.

OBJECTIVES

We assessed the cost-effectiveness of a screening, treatment, and condom provision intervention for inmates of a segregated unit for men who have sex with men at the Los Angeles County Men's Jail.

GOAL

We conducted the study to determine whether the intervention provides good value for money.

STUDY DESIGN

We used a mathematical model to examine the effect of 10 years of intervention on sexually transmitted infections in 3 scenarios for incarcerated men who have sex with men: (a) no sex; (b) sex as before incarceration; (c) as in #2 and condom use by 20% of screened inmates. We calculated cost-effectiveness ratios as net cost per infection averted after subtracting averted treatment costs from intervention costs.

RESULTS

Modeling suggests that the intervention could avert 339 chlamydia, 276 gonorrhea, and 241 syphilis infections in scenario 1 (net cost $179,121); 593 chlamydia, 586 gonorrhea, and 367 syphilis infections in scenario 2 (with cost saving); and 746 chlamydia, 791 gonorrhea, 3 HIV, and 443 syphilis infections in scenario 3 (with cost saving).

CONCLUSIONS

Modeling indicates that the intervention can avert many sexually transmitted infections at low cost and can save costs in a scenario in which inmates continue to engage in sexual activity as they do outside jail. Modest success in efforts to promote condom use among inmates results in additional cost saving.