Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of HIV and STD Programs, Michigan Department of Health and Human Services, Detroit, Michigan.
J Adolesc Health. 2021 Dec;69(6):957-963. doi: 10.1016/j.jadohealth.2021.05.014. Epub 2021 Jul 18.
The Michigan Department of Health and Human Services, in collaboration with St. John Providence Health System, initiated voluntary school-wide sexually transmitted disease (STD) screenings in four Detroit public high schools. We sought to assess the cost-effectiveness of the STD screening program from 2010 to 2015, with a focus on chlamydia.
The costs and effectiveness of the school-based screening were compared with those of a "no school screening" scenario using a healthcare system perspective. A decision tree model was constructed to project cases of chlamydia, epididymitis, and pelvic inflammatory disease (PID) in each of the two scenarios among students tested positive and their partners. Health effects were measured as cases of PID prevented, and quality-adjusted life-years (QALYs) gained. Cost estimates included program costs, chlamydia testing/treatment costs in the absence of school screening, and treatment costs for epididymitis, PID, and PID sequelae. The incremental cost-effectiveness ratio (ICER) was measured as cost/QALY gained. Multivariate sensitivity analyses were conducted on key parameter estimates and assumptions used.
Under base-case assumptions, at a total program cost of $333,848 over 5 years, the program prevented an estimated 1.9 cases of epididymitis and 17.3 cases of PID, resulting in an ICER of $38,235/QALY gained (yearly ICER ranging from $27,417 to $50,945/QALY). Of 10,000 Monte Carlo simulation runs, the yearly ICER remained ≤$50,000/QALY in 64%-98% of the simulation runs.
We found favorable cost-effectiveness ratios for Michigan's school-wide STD screening program in Detroit. School-based STD screening programs of this type warrant careful considerations by policy makers and program planners.
密歇根州卫生与公众服务部与圣约翰普罗维登斯健康系统合作，在底特律的四所公立高中启动了自愿的全校性性传播疾病（STD）筛查。我们旨在评估 2010 年至 2015 年 STD 筛查计划的成本效益，重点关注衣原体。
从医疗保健系统的角度出发，将基于学校的筛查成本和效果与“无学校筛查”方案进行了比较。构建决策树模型，以预测在两种方案下，在接受测试的学生及其伴侣中，每个方案的衣原体、附睾炎和盆腔炎（PID）病例。健康效果以预防 PID 的病例数和获得的质量调整生命年（QALY）来衡量。成本估算包括计划成本、无学校筛查时的衣原体检测/治疗成本以及附睾炎、PID 和 PID 后遗症的治疗成本。增量成本效益比（ICER）的衡量标准为成本/QALY 获得。对关键参数估计和假设进行了多变量敏感性分析。
在基本情况下，该计划在 5 年内的总成本为 333848 美元，估计预防了 1.9 例附睾炎和 17.3 例 PID，ICER 为 38235 美元/QALY 获得（每年 ICER 范围为 27417 美元至 50945 美元/QALY）。在 10000 次蒙特卡罗模拟运行中，在 64%-98%的模拟运行中，每年的 ICER 保持在 50000 美元/QALY 以下。
我们发现密歇根州底特律全校性 STD 筛查计划具有良好的成本效益比。此类基于学校的 STD 筛查计划值得政策制定者和计划规划者的仔细考虑。
