Guoyu Tao

The Estimated Direct Medical Cost of Sexually Transmitted Diseases Among American Youth, 2000

CONTEXTnEach year, millions of U.S. youth acquire sexually transmitted diseases (STDs). Estimates of the economic burden of STDs can help to quantify the impact of STDs on the nations youth and on the payers of the cost of their medical care.nnnMETHODSnWe synthesized the existing literature on STD costs to estimate the lifetime medical cost per case of eight major STDs-HIV, human papillomavirus (HPV), genital herpes simplex virus type 2, hepatitis B, chlamydia, gonorrhea, trichomoniasis and syphilis. We then estimated the total burden of disease by multiplying these cost-per-case estimates by the approximate number of new cases of STDs acquired by youth aged 15-24.nnnRESULTSnThe total estimated burden of the nine million new cases of these STDs that occurred among 15-24-year-olds in 2000 was

Heterosexual anal sex activity in the year after an STD clinic visit.

6.5 billion (in year 2000 dollars). Viral STDs accounted for 94% of the total burden (

Missed opportunities to assess sexually transmitted diseases in U.S. adults during routine medical checkups

6.2 billion), and nonviral STDs accounted for 6% of the total burden (

Chlamydia screening in a Health Plan before and after a national performance measure introduction.

0.4 billion). HIV and HPV were by far the most costly STDs in terms of total estimated direct medical costs, accounting for 90% of the total burden (

Rates of receiving HIV test results: data from the U.S. National Health Interview Survey for 1994 and 1995.

5.9 billion).nnnCONCLUSIONSnThe large number of infections acquired by persons aged 15-24 and the high cost per case of viral STDs, particularly HIV, create a substantial economic burden.

Medical care expenditures for genital herpes in the United States.

Objectives: To describe heterosexual anal sex activity during a year and to identify factors associated with heterosexual anal sex and condom use during anal sex. Methods: Secondary analysis of data from a trial conducted in 3 public sexually transmitted disease (STD) clinics. Patients described sexual behaviors every 3-months for the year. Logistic regression models with generalized estimating equations were used to include multiple observations for each subject. Results: Two thousand three hundred fifty-seven heterosexual subjects reported on 6611 3-month intervals that included 9235 partnerships. About 18.3% of subjects had anal sex in a particular 3-month interval and 39.3% in the year. About 23.5% of subjects had anal sex in at least two 3-month intervals in the year. Anal sex was associated with having more sex acts, 2 or more sex partners, unprotected vaginal sex, and a main partner. For anal sex in the past 3 months, 27.3% of subjects consistently used condoms, and 63% of subjects never used condoms. Consistent condom use for anal sex was associated with having consistent condom use for vaginal sex, 2 or more partners, and anal sex with casual or new partner. Conclusion: STD clinic patients were commonly engaged in heterosexual anal sex, and most of them never used condoms during anal sex. Patients who had anal sex tended to also engage in other risk behaviors that put them at risk of STD/human immunodeficiency virus. Clinicians should ask about anal sex, appropriately examine and test patients who have had anal sex, and recommend condom use for both anal and vaginal sex.

Predictive value of clinical diagnostic codes for the CDC case definition of pelvic inflammatory disease (PID): implications for surveillance.

OBJECTIVESnAlthough sexually transmitted diseases (STDs) cause tremendous health and economic burdens in our society, awareness and knowledge regarding STDs remain poor among health care providers. To examine missed opportunities for STD-related counseling, diagnosis and treatment, we investigated how frequently U.S. adults reported being asked about STDs by their health care providers during routine checkups.nnnMETHODSnWe analyzed the responses of 3390 adults aged 18-64 who reported having a routine checkup during the past year in the 1994 U.S. National Health Interview Survey (NHIS), a nationally representative survey. We used a logistic model to determine factors that were independently associated with the likelihood of being asked about STDs during the checkup.nnnRESULTSnOnly 28% (+/-0.9%) of respondents reported being asked about STDs during their last routine checkup. Persons were significantly more likely (p<0.05) to be asked about STDs if they were aged under 45, male, single, had a household income under the federal poverty level, or were insured by a health maintenance organization, public coverage or by no plan rather than by a fee-for-service arrangement.nnnCONCLUSIONSnOnly about one quarter of U.S. adults reported being asked about STDs during routine checkups. Routine checkups in which these issues are not discussed may represent missed opportunities for STD prevention. Persons presenting for routine care can be counseled, screened and, if infected, can be treated. Interventions are needed at the patient, provider, and community levels to increase the opportunities to assess STD risk, to counsel, to diagnose, and to treat infections during routine checkups.

Estimating Chlamydia Screening Rates by Using Reported Sexually Transmitted Disease Tests for Sexually Active Women Aged 16 to 25 Years in the United States

Objective: To evaluate chlamydia-screening policies, testing practices, and the proportion testing positive in response to the new Health Plan Employer Data and Information Set (HEDIS) chlamydia-screening performance measure in a large commercial health plan. Methods: We interviewed health plan specialty departmental chiefs to describe interventions used to increase chlamydia screening and examined electronic medical records of 15- to 26-year-old female patients—37,438 from 1998 to 1999 and 37,237 from 2000 to 2001—who were classified as sexually active by HEDIS specifications to estimate chlamydia testing and positive tests 2 years before and after the HEDIS measure introduction. Results: In January 2000, the obstetrics and gynecology department instituted a policy to collect chlamydia tests at the time of routine Pap tests on all females 26 years old or younger by placing chlamydia swabs next to Pap test collection materials. Other primary care departments provided screening recommendations and provider training. During 1998–1999, 57% of eligible female patients seen by obstetrics and gynecology exclusively and 63% who were also seen by primary care were tested for chlamydia; in 2000–2001 the proportions tested increased to 81% (P < .001) and 84% (P < .001). Proportions tested by other primary care specialists did not increase substantially: 30% in 1998–1999 to 32% in 2000–2001. The proportion of females testing positive remained high after testing rates increased: 8% during 1998–1999 and 7% during 2000–2001, and the number of newly diagnosed females increased 10%. Conclusion: After the obstetrics and gynecology department introduced a simple systems-level change in response to the HEDIS measure, the proportion of females chlamydia-tested and number of newly diagnosed females increased. Level of Evidence: II-2

Understanding Sexual Activity Defined in the HEDIS Measure of Screening Young Women for Chlamydia trachomatis

OBJECTIVEnTo determine the frequency and predictors of receipt of HIV test results.nnnMETHODSnAnalysis of responses from 19,127 adults in 1994 and 16,848 in 1995 surveyed for the U.S. National Health Interview Survey, using logit models to determine factors independently associated with decreased likelihood of receiving HIV test results.nnnRESULTSnOverall, 12.5% (+/-1.0%) of persons tested in 1994 and 13.3% (+/-0.9%) in 1995 had not received their test results. Those whose test was not self-initiated were significantly less likely (p<.05) to receive their test results. The proportion who did not receive results was lowest among persons who had sought testing (6.1% in 1994 and 4.3% in 1995) and highest among persons whose tests were required for hospitalization or surgery (24.2% in 1994 and 22.9% in 1995).nnnCONCLUSIONSnAn estimated 2.3 million of the 17.5 million people tested annually for HIV infection did not receive their test results. Alternative measures to increase the number of persons who receive their results need to be evaluated. These may include enhancing prevention counseling about the importance of receiving test results, telephone notification, or using rapid HIV-screening tests that provide results at the time of testing.

Services Provided to Nonpregnant Women During General Medical and Gynecologic Examinations in the United States

Background: Approximately 45 million Americans have serologic evidence of HSV‐2 infection and HSV‐2 seroprevalence in the United States has increased 30% over the past two decades. Despite rapid increases in HSV‐2 prevalence, the last estimate of the U.S. national direct medical cost for genital herpes (GH) was completed in 1985. The objective of this study is to assess the U.S. direct medical expenditures for GH and its complications to assist policy makers in allocating limited STD resources efficiently. Methods: We estimated the number of GH‐related clinical visits and pharmacy claims from several national and state sources, estimated the average direct medical cost per visit from two administrative claims databases, and calculated the U.S. national direct medical costs for GH by applying the average direct medical cost per visit to the number of clinical visits and pharmacy claims. Results: The U.S. national number of GH‐related clinical visits was estimated to be 499,655 and there were approximately 2,056,080 pharmacy claims annually. Of those clinical visits, private office‐based physician and public STD clinic visits alone accounted for 89%. The U.S. national direct medical costs were estimated at