HIV Insight: Cost-Effectiveness of Screening Men in Maricopa County Jails for Chlamydia and Gonorrhea to Avert Infections in Women

Chlamydia and gonorrhea infections can lead to serious and costly sequelae in women, but sequelae in men are rare. In accordance with the Centers for Disease Control and Prevention guidelines, female jail inmates in Maricopa County (Phoenix area), Arizona, are screened for these infections. Owing to lack of evidence of screening benefits in men, male inmates are tested and treated based on symptoms only.

We developed a probabilistic simulation model to simulate chlamydia and gonorrhea infections in Maricopa County jail male inmates and transmissions to female partners per year. We estimated the cost-effectiveness of screening as the cost per infection averted. Costs were estimated from the perspective of the Maricopa County Department of Public Health and the Correctional Health Services.

Compared with symptom-based testing and treating strategy, screening male arrestees of all ages and only those 35 years or younger yielded the following results:

averted approximately 556 and 491 cases of infection in women at a cost of approximately US $1240 and $860 per case averted, respectively,

if screened during physical examination (between days 8 and 14 from entry to jail),

and averted approximately 1100 and 995 cases of infections averted at a cost of US $1030 and $710 per infection averted, respectively,

if screened early, within 2 to 3 days from entry to jail.

Screening of male inmates incurs a modest cost per infection averted in women compared with symptom-based testing. Screening in correctional settings can be used by public health programs to reduce disease burden, sequelae, and associated costs.

Below: Average cost-effectiveness measure (in dollars per infection averted compared with baseline symptom-based testing scenario) under sensitivity analyses