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The Cost and Cost-Effectiveness of Expedited Partner Therapy Compared With Standard Partner Referral for the Treatment of Chlamydia or Gonorrhea

Gift, Thomas L. PhD*; Kissinger, Patricia PhD; Mohammed, Hamish PhD, MPH; Leichliter, Jami S. PhD*; Hogben, Matthew PhD*; Golden, Matthew R. MD, MPH§¶

doi: 10.1097/OLQ.0b013e31822e9192
Original Study

Background: Partner treatment is an important component of sexually transmitted disease control. Several randomized controlled trials have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, whereas some found that EPT significantly lowered reinfection rates in index patients.

Methods: We collected cost data to assess the payer-specific, health care system, and societal-level cost of EPT and SR. We used data on partner treatment and index patient reinfection rates from 2 randomized controlled trials examining EPT and SR for patients diagnosed with chlamydia or gonorrhea. Additional elements were estimated or drawn from the literature. We used a Monte Carlo simulation to assess the impact on cost and effectiveness of varying several variables simultaneously, and calculated threshold values for selected variables at which EPT and SR costs per patient were equal.

Results: From a health care system or societal perspective, EPT was less costly and it treated more partners than SR. From the perspective of an individual payer, EPT was less costly than SR if ≥32% to 37% of male index patients' female partners or ≥29% of female index patients' male partners received care from the same payer.

Conclusions: EPT has a lower cost from a societal or health care system perspective than SR and treats more partners. Individual payers may find EPT to be more costly than SR, depending on how many of their patients' partners receive care from the same payer.

Expedited partner treatment for partners of patients diagnosed with chlamydia or gonorrhea has lower societal costs than standard partner referral, but payer-specific costs can be higher for expedited partner treatment.

*Centers for Disease Control and Prevention, Atlanta, GA; †Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; ‡The University of Trinidad and Tobago, Trinidad, West Indies; §University of Washington Center for AIDS & STD, Seattle, WA; and ¶Public Health Seattle-King County, Seattle, WA

Supported by the National Institutes of Health (Grant Number R01AI068107) (to M.R.G.).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Correspondence: Thomas L. Gift, PhD, Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA 30333. E-mail: tgift@cdc.gov.

Received for publication April 13, 2011, and accepted July 18, 2011.

© Copyright 2011 American Sexually Transmitted Diseases Association