William J. Kassler

Direct medical cost of pelvic inflammatory disease and its sequelae : Decreasing, but still substantial

Objective To estimate direct medical costs and average lifetime cost per case of pelvic inflammatory disease (PID). Methods We estimated the direct medical expenditures for PID and its three major sequelae (chronic pelvic pain, ectopic pregnancy, and infertility) and determined the average lifetime cost of a case of PID and its sequelae. We analyzed 3 years of claims data of privately insured individuals to determine costs, and 3 years of national survey data to determine number of cases of PID, chronic pelvic pain, and ectopic pregnancy. We developed a probability model to determine the average lifetime cost of a case of PID. Results Direct medical expenditures for PID and its sequelae were estimated at

On-site, rapid HIV testing with same-day results and counseling

1.88 billion in 1998:

Sex Under the Influence: The Effect of Alcohol Policy on Sexually Transmitted Disease Rates in the United States*

1.06 billion for PID,

The rapid test paradox: when fewer cases detected lead to more cases treated: a decision analysis of tests for Chlamydia trachomatis.

166 million for chronic pelvic pain,

Rapid HIV testing with same-day results : a field trial in Uganda

295 million for ectopic pregnancy, and

Seroconversion in patients attending sexually transmitted disease clinics

360 million for infertility associated with PID. The expected lifetime cost of a case of PID was

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

1167 in 1998 dollars. The majority of those costs (

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

843 per case) represent care for acute PID rather than diagnosis and treatment of sequelae. Approximately 73% of cases will not accrue costs beyond the treatment of acute PID. Conclusion The direct medical cost of PID is still substantial. The majority of PID related costs are incurred in the treatment of acute PID. Because most PID-related costs arise in the first year from treatment of acute PID infection, strategies that prevent PID are likely to be cost-effective within a single year.

New HIV cases attributable to syphilis in the USA: estimates from a simplified transmission model:

Background: New rapid HIV antibody tests have allowed provision of results and result‐specific counseling on the day of initial visit, and have the potential to increase the efficiency of HIV counseling and testing. Methods: To evaluate the use of rapid testing with same‐day results in public clinics, the Single Use Diagnostic System HIV‐1 rapid assay was used for a 3‐month period at an anonymous testing clinic and a sexually transmitted disease (STD) clinic in Dallas, Texas. Non‐reactive rapid test results were reported as HIV‐negative. Reactive results were reported as ‘preliminary positive’. These procedures were compared with standard testing during a baseline period, with respect to number of clients receiving results and post‐test counseling, client satisfaction, counselor acceptance, cost, and effectiveness at reducing HIV risk. Results: Rapid testing resulted in an increase in the number of persons learning their serostatus: a 4% increase for uninfected and a 16% increase for infected clients at the Anonymous Testing Clinic; a 210% increase for uninfected patients and a 23% increase for infected patients at the STD clinic. Rapid testing resulted in a cost saving of US

Medical care expenditures for genital herpes in the United States.

11 per test in both the anonymous and STD clinics. Of those previously tested, 88% responded that they preferred the rapid test. In the year following initial HIV test, clients tested with rapid and standard procedures were equally likely to return to the clinic with a new STD (odds ratio, 0.97; 95% confidence interval, 0.7‐1.4). Conclusions: Rapid, on‐site HIV testing was feasible, preferred by clients, and resulted in significant improvement in the number of persons learning their serostatus, without increasing the costs or decreasing the effectiveness of counseling and testing.