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Utilization and Cost of Diagnostic Methods for Sexually Transmitted Infection Screening Among Insured American Youth, 2008

Owusu-Edusei, Kwame Jr PhD, PMP; Nguyen, Hang T. BS; Gift, Thomas L. PhD

Sexually Transmitted Diseases: May 2013 - Volume 40 - Issue 5 - p 354–361
doi: 10.1097/OLQ.0b013e318285c58f
Original Study

Background: Private sector utilization and cost information on testing for sexually transmitted infections (STIs) in the United States is limited.

Methods: We used current procedural terminology codes for tests for HIV, human papillomavirus (HPV), genital herpes simplex virus type 2, hepatitis B virus, chlamydia, gonorrhea, trichomoniasis, and syphilis. We extracted outpatient claims for persons aged 15 to 24 years in 2008 from the MarketScan database. Utilization was measured as the number of claims per 100,000 enrollees for tests specific to a given infection. We estimated claims rates and average costs by sex, compared these with Centers for Medicare and Medicaid Services (CMS) fees, and estimated the overall total cost of STI testing.

Results: The claims rate for HPV was higher than for any other STI (P < 0.001) at 18,085/100,000, whereas that for trichomoniasis was lower than all other STIs (P < 0.001) at 517/100,000. Claims rates for females were higher than for males (P < 0.001) for all STIs. Average costs were as follows: $24 (HIV), $34 (HPV), $29 (hepatitis B virus), $25 (herpes simplex virus type 2), $43 (chlamydia), $42 (gonorrhea), $28 (trichomoniasis), and $24 (syphilis). Costs exceeded CMS fees for 67 of 78 current procedural terminologies by an average of 40%. The estimated total cost for all STIs was $403.1 million for the privately insured population aged 15 to 24 years.

Conclusions: We found that the utilization rates and many test costs varied by sex. Private insurers typically paid more than the CMS fee schedule for testing.

Sexually transmitted infection diagnostic tests from 2008 claims data indicated that utilization rate for human papillomavirus was the highest. The estimated total screening cost for the insured population (15–24 years old) was $403.1 million.

From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Conflict of interest: None declared.

Funding: None declared.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. Mention of company names or products does not imply endorsement by the Centers for Disease Control and Prevention.

Correspondence: Kwame Owusu-Edusei Jr, PhD, PMP, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-80, Atlanta, GA 30333. E-mail: Kowusuedusei@cdc.gov.

Received for publication June 16, 2012, and accepted December 26, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association