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