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Abban B, Tao G, Gift T, Irwin K Centers for Disease Control and Prevention (CDC)

A Unified Optimal Resource Allocation Model for Screening and Treating Asymptomatic Women for Chlamydia Trachomatis and Neisseria Gonorrhoeae. Abban B, Tao G, Gift T, Irwin K Centers for Disease Control and Prevention (CDC). Background.

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Abban B, Tao G, Gift T, Irwin K Centers for Disease Control and Prevention (CDC)

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  1. A Unified Optimal Resource Allocation Model for Screening and Treating Asymptomatic Women for Chlamydia Trachomatis and Neisseria Gonorrhoeae Abban B, Tao G, Gift T, Irwin K Centers for Disease Control and Prevention (CDC)

  2. Background • Up to 70% CT and up to 50% GC infections are asymptomatic • CT infection among GC infected populations can be as high 50% • Different segments of the population have different prevalences of CT, GC, and co-infection; range of disparities is wide • Availability of different testing technologies at varying cost and performance • Many clinics operate under fixed budgets and cannot accommodate universal screening

  3. Study Objective • Determines the optimal combination of screening coverage, test selection and treatment for CT and GC in asymptomatic women; specifically • At what prevalence is it cost-saving to screen a population for CT or GC? • Is it more beneficial to screen with more sensitive but more expensive tests? • Is presumptive treatment cost-saving?

  4. Clinical Management Decision Which risk-group(s) should be screened for CT, or GC, or both? What test(s) should be used? Should patient be dual-treated? What treatment(s) should be used?

  5. Clinical Alternatives Considered For each risk-group the following strategies are possible: • Screen and treat for CT only • Screen and treat for GC only • Screen and treat for both CT and GC • Screen and treat for CT only and presumptively treat for GC • Screen for and treat for GC only and presumptively treat for CT

  6. Methods • The optimal strategy was defined as one that maximized • the number of women cured or • the cost-saving value (cost of averted PID minus screening and treatment costs for CT and/or GC) • Selective screening based on readily ascertained risk-factor: Age • 4 tests each for CT and GC, including dual test(s) • 2 treatment regimens for CT and 3 for GC • A mixed integer optimization model for a hypothetical cohort of 1000 asymptomatic women

  7. Model Assumptions • All women who visited the clinic lacked symptoms of CT and GCinfections • A strategy could allow the screening of selected age groups or all patients • Return rate for treatment was assumed to be the same for all age groups • Test and treatment for each infection were the same all age groups

  8. Variables • CT and GC positivity by age group • Co-infection rates by age group • Tests sensitivity, specificity and cost • Treatments effectiveness and cost • All parameter values were from published literature

  9. Test Positivity Ratesby Clinic Type • Family planning clinic • STD clinic

  10. Variables - Test BDPT – Becton Dickinson Probe Tec

  11. Variables - Treatment

  12. Clinical Costs and Outcomes

  13. Results

  14. Test Positivity at which Screening is Cost-saving • Sensitive to PID cost

  15. Results – FP Clinic CT (2.3 - 10.6%), GC (0.4 - 1.2%), GC with CT (30.0 - 46.0%) †All costs in US dollars (2003) | BDPT – Becton Dickinson Probe Tec ‡ Optimal cost-saving strategy | pres. – presumptively treat

  16. Results – FP Clinic CT (2.3 - 10.6%), GC (0.4 - 1.2%), GC with CT (30.0 - 46.0%) †All costs in US dollars (2003) | BDPT – Becton Dickinson Probe Tec ‡ Optimal cost-saving strategy | pres. – presumptively treat

  17. Results – FP Clinic CT (2.3 - 10.6%), GC (0.4 - 1.2%), GC with CT (30.0 - 46.0%) †All costs in US dollars (2003) | BDPT – Becton Dickinson Probe Tec ‡ Optimal cost-saving strategy | pres. – presumptively treat

  18. Results – STD Clinic CT (3.0 – 12.5%), GC (2.0 – 8.1%), GC with CT (20.0 – 45.5%) †All costs in US dollars (2003) | BDPT – Becton Dickinson Probe Tec ‡ Optimal cost-saving strategy | pres. – presumptively treat

  19. Results – STD Clinic CT (3.0 – 12.5%), GC (2.0 – 8.1%), GC with CT (20.0 – 45.5%) †All costs in US dollars (2003) | BDPT – Becton Dickinson Probe Tec ‡ Optimal cost-saving strategy | pres. – presumptively treat

  20. Results – STD Clinic CT (3.0 – 12.5%), GC (2.0 – 8.1%), GC with CT (20.0 – 45.5%) †All costs in US dollars (2003) | BDPT – Becton Dickinson Probe Tec ‡ Optimal cost-saving strategy | pres. – presumptively treat

  21. Limitations • The alternative of screening and treating for CT and screening CT-positives for GC was not considered • Published range of values for direct cost attributable to PID is wide: (1,433 – 5,000) • Repeat infections were not considered • CT and GC positivity in asymptomatic STD clinic patients may be less than the reported population-wide rates

  22. Conclusions • Optimal control strategy varies with CT and GC positivity, CT-GC co-infection rates, total program budget, test costs and PID cost • Influence of treatment cost on overall program cost is minimal • A switch from one test to another may not yield significant change in the number of women cured • The optimal strategy from a cost-saving perspective and from a number-of-cures perspective may vary • The model provides a flexible tool to analyze different scenarios when identifying a control strategy for CT, GC, or both

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