Examining the cost-effectiveness of STI screenings in emergency departments


Are targeted screenings for sexually transmitted infections (STIs) or universally offered screenings more cost effective than not screening? An investigation offers some answers.

When discussing universal or targeted screening for a variety of conditions has been roundly debated. An investigation in JAMA Pediatrics examines which is more cost effective when screening teenagers and young adults who seeking acute care in pediatric emergency departments for Chlamydia trachomatis and Neisseria gonorrhoeae.1

The researchers’ examination was part of an ongoing, larger multicenter trial from the Pediatric Emergency Care Applied Research Network. The data sources included insurance claims data from the MarketScan database, reimbursement payments from the Centers for Medicare and Medicaid Services, English-language articles that had been indexed in MEDLINE, and the bibliographies from relevant articles. There were 3 screening strategies examined: not screening, targeted screening, and universally offered screening. The targeted screening also involved completing a sexual health survey, which provided an estimated sexually transmitted infection risk of at risk, high risk, or low risk.

As the events and the outcomes were simulated, the researchers had 10,000 hypothetical emergency department visits to examine. They found that there was a 3.6% prevalence of both chlamydia and gonorrhea in this hypothetical collection of 10,000 visits. The targeted screen for sexually transmitted infections led to the detection and successful treatment of 95 of 360 cases, which resulted in a cost of $313,063. Meanwhile, the universal screening found and treated 112 of 360 cases and resulted in costs of $515,503. The incremental cost-effectiveness ratio for targeted screening versus no screening was $6444. It was $12,139 when looking at universally offered screening versus targeted screenings.

The researchers concluded that both targeted and universally offered screenings for sexually transmitted infections were cost effective when compared to no screening in both finding and treating chlamydial and gonococcal infections in both adolescent and young adult patients who are receiving acute care. Additionally, universally offered screening was linked to detecting and treating a higher proportion of sexually transmitted infections.


1. Eckman M, Reed J, Trent M, Goyal M. Cost-effectiveness of sexually transmitted infection screening for adolescents and young adults in the pediatric emergency department. JAMA Pediatr. November 3, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.3571

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