Cost of Screening Outside of IPP Chlamydia Screening Guidelines

1. Cost of Screening Outside of IPP Chlamydia Screening Guidelines Andee Krasner, MPH Region I IPP Advisory Board Meeting June 6th, 2011

2. Background • Cost of screening outside Chlamydia Screening Guidelines presented June 2010—data for 3 states, 2009-2010 • Goal: develop tool for use by STD Directors to determine annual cost of screening outside guidelines • ME piloted tool October 2010, copies distributed at November 2010 meeting • Programs used tool for first time April 2011

3. Methods for Developing the Cost Analysis Tool • Key informant interviews conducted in 2009 for original cost analysis • Used to determine all steps of testing, end-to-end • State IPP testing programs vary – the tool had to be flexible, but still collect same basic data across programs

4. Methods for Collecting Data • Some programs have data from their budgets; others estimate. Asked states to indicate how much of data was estimated. • How reliable are the data? • More than half of data were estimated

5. 2010: Percent of CT Tests Done Outside Guidelines • Outside guidelines: 25-26 or older; no risk factors and no clinical signs of infection • 30,722 tests done in women • 2,214 outside guidelines • Region I Average: 6%outside guidelines (Range: 1-19%)

6. Positivity Rate of Tests Outside Guidelines • Average CT positivity rate of women screened outside guidelines, across six states? 2% (Range: 0-2.93%) • Below recommended 3% rate to be cost effective

7. Average Cost of CT Test Paid for by IPP Average cost of CT test done outside IPP screening guidelines: $11.29 No one uses IPP budget to pay for all costs

8. Real Costs of Testing • Analysis includes only IPP test costs, not the full cost: • Only one state paid for some medical services as part of IPP funding • Cost for specimen collection and client communication was estimated to be far greater than what was paid to clinics to provide the service • Not all lab processing costs accounted for

9. Impact on IPP Budget • Average percent of budget spent on tests outside screening guidelines: 2% (range 1%-17%) • Impact of testing outside screening guidelines goes beyond IPP budget

10. Conclusions • CT positivity doesn’t support screening outside guidelines • Money could be used to target populations with higher positivity • True cost of screening outside CT screening guidelines goes beyond IPP paid tests, and impacts clinic and lab costs

11. Questions?