Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 31 Records) |
Query Trace: Owusu-Edusei K Jr[original query] |
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County-level social capital and bacterial sexually transmitted infections in the United States
Owusu-Edusei KJr , McClendon-Weary B , Bull L , Gift TL , Aral SO . Sex Transm Dis 2019 47 (3) 165-170 BACKGROUND: The association between county-level social capital indices (SCIs) and the three most commonly reported sexually transmitted infections (STIs) in the United States is lacking. In this study, we determined and examined the association between two recently developed county-level SCIs (i.e., Penn State social capital index [PSSCI] vs. United States Congress social capital index [USCSCI]) and the three most commonly reported bacterial STIs (chlamydia, gonorrhea and syphilis) using spatial and non-spatial regression techniques. METHODS: We assembled and analyzed multi-year (2012-2016) cross-sectional data on STIs and two SCIs (PSSCI vs. USCSCI) on counties in all 48 contiguous states. We explored two non-spatial regression models (univariate and multiple generalized linear models) and three spatial regression models (spatial lag model, spatial error model and the spatial autoregressive moving average model) for comparison. RESULTS: Without exception, all the SCIs were negatively associated with all three STI morbidity. A one-unit increase in the SCIs were associated with at least 9% (p<0.001) decrease in each STI. Our test of the magnitude of the estimated associations indicated that the USCSCI was at least two-times higher than the estimates for the PSSCI for all STIs (highest p-value=0.01). CONCLUSIONS: Overall, our results highlight the potential benefits of applying/incorporating social capital concepts to STI control and prevention efforts. In addition, our results suggest that for the purpose of planning, designing and implementing effective STI control and prevention interventions/programs, understanding the communities' associational life (as indicated by the factors/data used to develop the USCSCI) may be important. |
Investigating multiple reported bacterial sexually transmitted infection hot spot counties in the United States: Ordered spatial logistic regression
Owusu-Edusei KJr , Chang BA . Sex Transm Dis 2019 46 (12) 771-776 PURPOSE: To identify and examine the correlates of multiple bacterial sexually transmitted infection (STI) hot spot counties in the United States. METHODS: We assembled and analyzed five years (2008-2012) of cross-sectional STI morbidity data to identify multiple bacterial STI (chlamydia, gonorrhea and syphilis) hot spot counties using hot spot analysis. Then, we examined the association between the multi-STI-hotspots and select multi-year (2008-2012) sociodemographic factors (data obtained from the American Community Survey) using ordered spatial logistic regression analyses. RESULTS: Of the 2,935 counties, the results indicated that 85 counties were hot spots for all three STIs [three-STI-hotspot counties], 177 were hot spots for two STIs [two-STI-hotspot counties], and 145 were hot spots for only one STI [one-STI-hotspot counties]. Approximately 93% (79/85) of the counties determined to be three-STI-hotspots were found in four Southern states--Mississippi (n=25), Arkansas (n=22), Louisiana (n=19), and Alabama (n=13). Counties determined to be two-STI-hotspots were found in seven Southern states--Arkansas, Louisiana, Mississippi, Alabama, Georgia, North and South Carolina had at least 10 two-STI-hotspot counties each. The multi-STI-hotspot classes were significantly (p<0.05) associated with percent Black (non-Hispanic), percent Hispanics, percent American Indians, population density, male-female sex ratio, percent aged 25-44 and violent crime rate. CONCLUSION: This study provides information on multiple STI hot spot counties in the United States and the associated sociodemographic factors. Such information can be used to assist planning, designing and implementing effective integrated bacterial STI prevention and control programs/interventions. |
Relative impact of different strategies for allocating federal funds for syphilis prevention
Chesson HW , Owusu-Edusei K Jr . Sex Transm Dis 2018 45 S72-S77 BACKGROUND: Improvements in resource allocation can increase the benefits of federally-funded sexually transmitted disease (STD) prevention activities. The purpose of this study was to illustrate how different strategies for allocating federal funds to sub-national districts for syphilis prevention might affect the incidence of syphilis at the national level. METHODS: We modeled syphilis rates by district and year using an equation based on a previous analysis of state-level syphilis elimination funding and syphilis case rates from 1998 to 2005 in the United States. We used the model to illustrate the potential impact of three different strategies for allocating supplemental federal funds to sub-national districts to support syphilis prevention activities a hypothetical country with 18 sub-national districts. The three strategies were based on each district's (1) population size, (2) syphilis incidence rate, or (3) number of syphilis cases. The hypothetical country was similar to the United States in overall population and syphilis burden. RESULTS: Without the supplemental federal funds, there would be an estimated 48,600 incident infections annually in the hypothetical country. With the supplemental federal funds, the annual number of infections would be reduced to 27,800 with a population-based allocation of funding to each district, 26,700 with a rate-based allocation, and 24,400 with a case-based allocation of funding. CONCLUSIONS: Allocating federal STD prevention funds to districts based on burden of disease can be an efficient strategy, although this efficiency may be reduced or eliminated when high burden districts have less ability to provide adequate STD prevention services than lower burden districts. |
Tuberculosis test usage and medical expenditures from outpatient insurance claims data, 2013
Owusu-Edusei K Jr , Winston CA , Marks SM , Langer AJ , Miramontes R . Tuberc Res Treat 2017 2017 3816432 Objective: To evaluate TB test usage and associated direct medical expenditures from 2013 private insurance claims data in the United States (US). Methods: We extracted outpatient claims for TB-specific and nonspecific tests from the 2013 MarketScan(R) commercial database. We estimated average expenditures (adjusted for claim and patient characteristics) using semilog regression analyses and compared them to the Centers for Medicare and Medicaid Services (CMS) national reimbursement limits. Results: Among the TB-specific tests, 1.4% of the enrollees had at least one claim, of which the tuberculin skin test was most common (86%) and least expensive ($9). The T-SPOT(R) was the most expensive among the TB-specific tests ($106). Among nonspecific TB tests, the chest radiograph was the most used test (78%), while chest computerized tomography was the most expensive ($251). Adjusted average expenditures for the majority of tests ( approximately 74%) were above CMS limits. We estimated that total United States medical expenditures for the employer-based privately insured population for TB-specific tests were $53.0 million in 2013, of which enrollees paid 17% ($9 million). Conclusions: We found substantial differences in TB test usage and expenditures. Additionally, employer-based private insurers and enrollees paid more than CMS limits for most TB tests. |
The spatial association between federally qualified health centers and county-level reported sexually transmitted infections: A spatial regression approach
Owusu-Edusei K Jr , Gift TL , Leichliter JS , Romaguera RA . Sex Transm Dis 2017 45 (2) 81-86 BACKGROUND: The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques. METHODS: We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008-2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008-2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites. RESULTS: Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates. CONCLUSIONS: There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services. |
State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses
Owusu-Edusei K Jr , Cramer R , Chesson HW , Gift TL , Leichliter JS . Public Health 2017 147 101-108 OBJECTIVE: In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. STUDY DESIGN: Longitudinal study. METHODS: We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. RESULTS: For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. CONCLUSION: We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners. |
Tuberculin skin test and interferon-gamma release assay use among privately insured persons in the United States
Owusu-Edusei K Jr , Stockbridge EL , Winston CA , Kolasa M , Miramontes R . Int J Tuberc Lung Dis 2017 21 (6) 684-689 OBJECTIVE: To describe tuberculin skin test (TST) and interferon-gamma release assay (IGRA) (i.e., QuantiFERON-TB and T-SPOT.TB [T-SPOT]) use among privately insured persons in the United States over a 15-year period. METHODS: We used current procedural terminology (CPT) codes for the TST and IGRAs to extract out-patient claims (2000-2014) and determined usage (claims/100,000). The chi2 test for trend in proportions was used to describe usage trends for select periods. RESULTS: The TST was the dominant (>80%) test in each year. Publication of guidelines preceded the assignment of QFT and T-SPOT CPT codes by 1 year (2006 for QFT; 2011 for T-SPOT). QFT usage was higher (P < 0.01) than T-SPOT in each year. The average annual increase in the use of QFT was higher than that of T-SPOT (35 vs. 3.8/100,000), and more so when the analytic period was 2011-2014 (65 vs. 38/100,000). However, during that 4-year period (2011-2014), TST use trended downward, with an average annual decrease of 28/100,000. The annual proportion of enrollees tested ranged from 1.1% to 1.5%. CONCLUSIONS: These results suggest a gradual shift from the use of the TST to the newer IGRAs. Future studies can assess the extent, if any, to which the shift from the use of the TST to IGRAs evolved over time. |
Correlates of county-level nonviral sexually transmitted infection hot spots in the US: application of hot spot analysis and spatial logistic regression
Chang BA , Pearson WS , Owusu-Edusei K Jr . Ann Epidemiol 2017 27 (4) 231-237 PURPOSE: We used a combination of hot spot analysis (HSA) and spatial regression to examine county-level hot spot correlates for the most commonly reported nonviral sexually transmitted infections (STIs) in the 48 contiguous states in the United States (US). METHODS: We obtained reported county-level total case rates of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis in all counties in the 48 contiguous states from national surveillance data and computed temporally smoothed rates using 2008-2012 data. Covariates were obtained from county-level multiyear (2008-2012) American Community Surveys from the US census. We conducted HSA to identify hot spot counties for all three STIs. We then applied spatial logistic regression with the spatial error model to determine the association between the identified hot spots and the covariates. RESULTS: HSA indicated that ≥84% of hot spots for each STI were in the South. Spatial regression results indicated that, a 10-unit increase in the percentage of Black non-Hispanics was associated with approximately 42% (P < 0.01) [ approximately 22% (P < 0.01), for Hispanics] increase in the odds of being a hot spot county for chlamydia and gonorrhea, and approximately 27% (P < 0.01) [ approximately 11% (P < 0.01) for Hispanics] for P&S syphilis. Compared with the other regions (West, Midwest, and Northeast), counties in the South were 6.5 (P < 0.01; chlamydia), 9.6 (P < 0.01; gonorrhea), and 4.7 (P < 0.01; P&S syphilis) times more likely to be hot spots. CONCLUSION: Our study provides important information on hot spot clusters of nonviral STIs in the entire United States, including associations between hot spot counties and sociodemographic factors. |
Does place of service matter? A utilisation and cost analysis of sexually transmissible infection testing from 2012 claims data
Owusu-Edusei K Jr , Patel CG , Gift TL . Sex Health 2016 13 (2) 131-139 Background: In this study, a previous study on the utilisation and cost of sexually transmissible infection (STI) tests was augmented by focusing on outpatient place of service for the most utilised tests. Methods: Claims for eight STI tests [chlamydia, gonorrhoea, hepatitis B virus (HBV), HIV, human papillomavirus (HPV), herpes simplex virus type 2 (HSV2), syphilis and trichomoniasis] using the most utilised current procedural terminology (CPT) code for each STI from the 2012 MarketScan outpatient table were extracted. The volume and costs by gender and place of service were then summarised. Finally, semi-log regression analyses were used to further examine and compare costs. Results: Females had a higher number of test claims than males in all places of service for each STI. Together, claims from 'Independent Laboratories', 'Office' and 'Outpatient hospital' accounted for over 93% of all the test claims. The cost of tests were slightly (<5%) different between males and females for most places of service. Except for the estimated average cost for 'Outpatient hospital', the estimated average costs for the other categories were significantly lower (15-80%, P<0.01) than the estimated average cost for 'Emergency Room - Hospital' for all the STIs. Among the predominant service venues, test costs from 'Independent Laboratory' and 'Office' were 30% to 69% lower (P<0.01) than those from 'Outpatient Hospital'. Conclusions: Even though the results from this study are not generalisable, our study shows that almost all STI tests from outpatient claims data were performed in three service venues with considerable cost variations. |
Cost-effectiveness of opt-out chlamydia testing for high-risk young women in the U.S
Owusu-Edusei K Jr , Hoover KW , Gift TL . Am J Prev Med 2016 51 (2) 216-224 INTRODUCTION: In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective. METHODS: Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015. RESULTS: Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate. CONCLUSIONS: The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care. |
Estimating the total annual direct cost of providing sexually transmitted infection and HIV testing and counseling for men who have sex with men in the United States
Owusu-Edusei K Jr , Gift TL , Patton ME , Johnson DB , Valentine JA . Sex Transm Dis 2015 42 (10) 586-9 BACKGROUND: The Centers for Disease Control and Prevention recommends annual sexually transmitted infection (STI) and HIV testing and counseling for men who have sex with men (MSM) in the United States. We estimated the annual total direct medical cost of providing recommended STI and HIV testing and counseling services for MSM in the United States. METHODS: We included costs for 9 STI (including anatomic site-specific) tests recommended by the Centers for Disease Control and Prevention (HIV, syphilis, gonorrhea, chlamydia, hepatitis B viral infection, and herpes simplex virus type 2), office visits, and counseling. We included nongenital tests for MSM with exposure at nongenital sites. All cost data were obtained from the 2012 MarketScan outpatient claims database. Men were defined as MSM if they had a male sex partner within the last 12 months, which was estimated at 2.9% (2.6%-3.2%) of the male population in a 2012 study. All costs were updated to 2014 US dollars. RESULTS: The estimated average costs were as follows: HIV ($18 [$9-$27]), hepatitis B viral infection ($23 [$12-$35]), syphilis ($8 [$4-$11]), gonorrhea and chlamydia ($45 [$22-$67]) per anatomic site), herpes simplex virus type 2 ($27 [$14-$41]), office visit ($100 [$50-$149]), and counseling ($29 [$15-$44]). We estimated that the total annual direct cost of a universal STI and HIV testing and counseling program was $1.1 billion ($473 million-$1.7 billion) for all MSM and $756 (range, $338-$1.2 billion) when excluding office visit cost. CONCLUSIONS: These estimates provide the potential costs associated with universal STI and HIV testing and counseling for MSM in the United States. This information may be useful in future cost and/or cost-effectiveness analyses that can be used to evaluate STI and HIV prevention efforts. |
Examining fluoroquinolone claims among gonorrhea-associated prescription drug claims, 2000-2010
Owusu-Edusei K Jr , Carroll DS , Gift TL . Am J Prev Med 2015 49 (5) 761-764 INTRODUCTION: After the release of CDC's revised gonorrhea treatment guidelines in April 2007, a study reported the declining use of fluoroquinolones to treat gonorrhea among health departments participating in the Sexually Transmitted Disease Surveillance Network. In this study, we examine the proportion of fluoroquinolone claims among gonorrhea-associated prescription drug claims from a large insurance database from 2000 through 2010. METHODS: We extracted drug claims associated with gonorrhea diagnosis claims from the MarketScan database for 2000-2010 and calculated the proportion of the drug claims for fluoroquinolones on a monthly basis. We then used an interrupted time series analysis to investigate trend characteristics of fluoroquinolone claims before and after the gonorrhea treatment guidelines were revised in April 2007. RESULTS: Although there was a monthly decline in the proportion of fluoroquinolone claims before April 2007 (-0.11 percentage points, p<0.01), results indicate a sevenfold (-0.78 percentage points, p<0.01) increase in the rate of decline after the revised guidelines were released in April 2007. We did not find any sudden drop (immediate or delayed) in the proportion of fluoroquinolones after April 2007, implying a gradual permanent decline over the analytic period. CONCLUSIONS: Our results are consistent with the findings of the previous study and indicate a gradual and permanent decline (over the analytic period) in the proportion of fluoroquinolone claims among gonorrhea-associated prescription drug claims. However, because this is a convenience sample of claims data, these findings cannot be generalized to the entire privately insured population in the U.S. |
Cost-effectiveness of chlamydia vaccination programs for young women
Owusu-Edusei K Jr , Chesson HW , Gift TL , Brunham RC , Bolan G . Emerg Infect Dis 2015 21 (6) 960-8 We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15-24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15-24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective. |
Antiviral treatment among pregnant women with chronic hepatitis B
Fan L , Owusu-Edusei K Jr , Schillie SF , Murphy TV . Infect Dis Obstet Gynecol 2014 2014 546165 OBJECTIVE: To describe the antiviral treatment patterns for chronic hepatitis B (CHB) among pregnant and nonpregnant women. METHODS: Using 2011 MarketScan claims, we calculated the rates of antiviral treatment among women (aged 10-50 years) with CHB. We described the pattern of antiviral treatment during pregnancy and ≥1 month after delivery. RESULTS: We identified 6274 women with CHB during 2011. Among these, 64 of 507 (12.6%) pregnant women and 1151 of 5767 (20.0%) nonpregnant women received antiviral treatment (P < 0.01). Pregnant women were most commonly prescribed tenofovir (73.4%) and lamivudine (21.9%); nonpregnant women were most commonly prescribed tenofovir (50.2%) and entecavir (41.3%) (P < 0.01). Among 48 treated pregnant women with an identifiable delivery date, 16 (33.3%) were prescribed an antiviral before pregnancy and continued treatment for at least one month after delivery; 14 (29.2%) started treatment during the third trimester and continued at least one month after delivery. CONCLUSION: Among this insured population, pregnant women with CHB received an antiviral significantly less often than nonpregnant women. The most common antiviral prescribed for pregnant women was tenofovir. These data provide a baseline for assessing changes in treatment patterns with anticipated increased use of antivirals to prevent breakthrough perinatal hepatitis B virus infection. |
Hospitalization cost per case of neonatal herpes simplex virus infection from claims data
Owusu-Edusei K Jr , Flagg EW , Gift TL . J Pediatr Nurs 2014 30 (2) 346-52 The purpose of this study was to estimate the average excess inpatient cost of neonatal herpes simplex virus (NHSV) infection from 2005 to 2009 insurance claims data. The estimated adjusted average excess inpatient cost for neonate admissions with HSV diagnosis and >7days of hospitalization was $40,044 [95% confidence interval (CI), $33,529-$47,775]. When disaggregated by the days of admission, cost estimates were: 8-13days, $23,918 [CI, $19,490-$29,282]; 14-21days, $44,358 [CI, $34,654-$56,673]; >21days, $68,916 [CI, $49,905-$94,967]). Although these estimates are not representative of the entire US, they can inform future economic evaluation studies on NHSV interventions. |
Cost-effectiveness of testing hepatitis B-positive pregnant women for hepatitis B e antigen or viral load
Fan L , Owusu-Edusei K Jr , Schillie SF , Murphy TV . Obstet Gynecol 2014 123 (5) 929-937 OBJECTIVE: To estimate the cost-effectiveness of testing pregnant women with hepatitis B (hepatitis B surface antigen [HBsAg]-positive) for hepatitis B e antigen (HBeAg) or hepatitis B virus (HBV) DNA, and administering maternal antiviral prophylaxis if indicated, to decrease breakthrough perinatal HBV transmission from the U.S. health care perspective. METHODS: A Markov decision model was constructed for a 2010 birth cohort of 4 million neonates to estimate the cost-effectiveness of two strategies: testing HBsAg-positive pregnant women for 1) HBeAg or 2) HBV load. Maternal antiviral prophylaxis is given from 28 weeks of gestation through 4 weeks postpartum when HBeAg is positive or HBV load is high (10 copies/mL or greater). These strategies were compared with the current recommendation. All neonates born to HBsAg-positive women received recommended active-passive immunoprophylaxis. Effects were measured in quality-adjusted life-years (QALYs) and all costs were in 2010 U.S. dollars. RESULTS: The HBeAg testing strategy saved $3.3 million and 3,080 QALYs and prevented 486 chronic HBV infections compared with the current recommendation. The HBV load testing strategy cost $3 million more than current recommendation, saved 2,080 QALYs, and prevented 324 chronic infections with an incremental cost-effectiveness ratio of $1,583 per QALY saved compared with the current recommendations. The results remained robust over a wide range of assumptions. CONCLUSION: Testing HBsAg-positive pregnant women for HBeAg or HBV load followed by maternal antiviral prophylaxis if HBeAg-positive or high viral load to reduce perinatal hepatitis B transmission in the United States is cost-effective. |
Ciprofloxacin resistance and gonorrhea incidence rates in 17 cities, United States, 1991-2006
Chesson HW , Kirkcaldy RD , Gift TL , Owusu-Edusei K Jr , Weinstock HS . Emerg Infect Dis 2014 20 (4) 612-9 Antimicrobial drug resistance can hinder gonorrhea prevention and control efforts. In this study, we analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level. We analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991-2006. We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection. These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance. |
Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China
Owusu-Edusei K Jr , Tao G , Gift TL , Wang A , Wang L , Tun Y , Wei X , Wang L , Fuller S , Kamb ML , Bulterys M . Sex Transm Dis 2014 41 (2) 103-10 BACKGROUND: In China, recent rises in syphilis and HIV cases have increased the focus on preventing mother-to-child transmission of these infections. We assess the health and economic outcomes of different strategies of prenatal HIV and syphilis screening from the local health department's perspective. METHODS: A Markov cohort decision analysis model was used to estimate the health and economic outcomes of pregnancy using disease prevalence and cost data from local sources and, if unavailable, from published literature. Adverse pregnancy outcomes included induced abortion, stillbirth, low birth weight, neonatal death, congenital syphilis in live-born infants, and perinatal HIV infection. We examined 4 screening strategies: no screening, screening for HIV only, for syphilis only, and for both HIV and syphilis. We estimated disability-adjusted life years (DALYs) for each health outcome using life expectancies and infections for mothers and newborns. RESULTS: For a simulated cohort of 10,000 pregnant women (0.07% prevalence for HIV and 0.25% for syphilis; 10% of HIV-positives were coinfected with syphilis), the estimated costs per DALY prevented were as follows: syphilis-only, $168; HIV-and-syphilis, $359; and HIV-only, $5636. The estimated incremental cost-effectiveness ratio if an existing HIV-only strategy added syphilis screening (i.e., move from the HIV-only strategy to the HIV-and-syphilis strategy) was $140 per additional DALY prevented. CONCLUSIONS: Given the increasing prevalence of syphilis and HIV among pregnant women in China, prenatal HIV screening programs that also include syphilis screening are likely to be substantially more cost-effective than HIV screening alone and prevent many more adverse pregnancy outcomes. |
Utilization and cost of diagnostic methods for sexually transmitted infection screening among insured American youth, 2008
Owusu-Edusei K Jr , Nguyen HT , Gift TL . Sex Transm Dis 2013 40 (5) 354-61 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. |
Investigating the potential public health benefit of jail-based screening and treatment programs for chlamydia
Owusu-Edusei K Jr , Gift TL , Chesson HW , Kent CK . Am J Epidemiol 2013 177 (5) 463-73 Observational studies have found mixed results on the impact of jail-based chlamydia screen-and-treat programs on community prevalence. In the absence of controlled trials or prospectively designed studies, dynamic mathematical models that incorporate movements in and out of jail and sexual contacts (including disease transmission) can provide useful information. We explored the impact of jail-based chlamydia screening on a hypothetical community's prevalence with a deterministic compartmental model focusing on heterosexual transmission. Parameter values were obtained from the published literature. Two analyses were conducted. One used national values (large community); the other used values reported among African Americans-the population with the highest incarceration rates and chlamydia burden (small community). A comprehensive sensitivity analysis was carried out. For the large-community analysis, chlamydia prevalence decreased by 13% (from 2.3% to 2.0%), and based on the ranges of parameter values (including screening coverage of 10%-100% and a postscreening treatment rate of 50%-100%) used in the sensitivity analysis, this decrease ranged from 0.1% to 58%. For the small-community analysis, chlamydia prevalence decreased by 54% (from 4.6% to 2.1%). Jail-based chlamydia screen-and-treat programs have the potential to reduce chlamydia prevalence in communities with high incarceration rates. However, the magnitude of this potential decrease is subject to considerable uncertainty. |
The association between racial disparity in income and reported sexually transmitted infections
Owusu-Edusei K Jr , Chesson HW , Leichliter JS , Kent CK , Aral SO . Am J Public Health 2013 103 (5) 910-6 OBJECTIVES: We examined the association between racial disparity in income and reported race-specific county-level bacterial sexually transmitted infections (STIs) in the United States focusing on disparities between Blacks and Whites. METHODS: Data are from the US 2000 decennial census. We defined 2 race-income county groups (high and low race-income disparity) on the basis of the difference between Black and White median household incomes. We used 2 approaches to examine disparities in STI rates across the groups. In the first approach, we computed and compared race-specific STI rates for the groups. In the second approach, we used spatial regression analyses to control for potential confounders. RESULTS: Consistent with the STI literature, chlamydia, gonorrhea, and syphilis rates for Blacks were substantially higher than were those for Whites. We also found that racial disparities in income were associated with racial disparities in chlamydia and gonorrhea rates and, to a lesser degree, syphilis rates. CONCLUSIONS: Racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income. |
The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008
Owusu-Edusei K Jr , Chesson HW , Gift TL , Tao G , Mahajan R , Ocfemia MC , Kent CK . Sex Transm Dis 2013 40 (3) 197-201 BACKGROUND: Millions of cases of sexually transmitted infections (STIs) occur in the United States each year, resulting in substantial medical costs to the nation. Previous estimates of the total direct cost of STIs are quite dated. We present updated direct medical cost estimates of STIs in the United States. METHODS: We assembled recent (i.e., 2002-2011) cost estimates to determine the lifetime cost per case of 8 major STIs (chlamydia, gonorrhea, hepatitis B virus, human immunodeficiency virus (HIV), human papillomavirus, genital herpes simplex virus type 2, trichomoniasis and syphilis). The total direct cost for each STI was computed as the product of the number of new or newly diagnosed cases in 2008 and the estimated discounted lifetime cost per case. All costs were adjusted to 2010 US dollars. RESULTS: Results indicated that the total lifetime direct medical cost of the 19.7 million cases of STIs that occurred among persons of all ages in 2008 in the United States was $15.6 (range, $11.0-$20.6) billion. Total costs were as follows: chlamydia ($516.7 [$258.3-$775.0] million), gonorrhea ($162.1 [$81.1-$243.2] million), hepatitis B virus ($50.7 [$41.3-$55.6] million), HIV ($12.6 [$9.5-$15.7] billion), human papillomavirus ($1.7 [$0.8-$2.9] billion), herpes simplex virus type 2 ($540.7 [$270.3-$811.0] million), syphilis ($39.3 [$19.6-$58.9] million), and trichomoniasis ($24.0 [$12.0-$36.0] million). Costs associated with HIV infection accounted for more than 81% of the total cost. Among the nonviral STIs, chlamydia was the most costly infection. CONCLUSIONS: Sexually transmitted infections continue to impose a substantial cost burden on the payers of medical care in the United States. The burden of STIs would be even greater in the absence of STI prevention and control efforts. |
Hospitalization cost of congenital syphilis diagnosis from insurance claims data in the United States
Owusu-Edusei K Jr , Introcaso CE , Chesson HW . Sex Transm Dis 2013 40 (3) 226-9 We analyzed medical insurance claims data (2005-2009) to determine the hospitalization costs of newborns with congenital syphilis (CS) diagnoses. We found 44 admission claims with CS diagnosis. The excess cost per case of CS (in 2009 US dollars) was estimated at $9969 (95% confidence interval, $5702-$16,769). |
Disparities in sexually transmitted disease rates across the "eight Americas"
Chesson HW , Kent CK , Owusu-Edusei K Jr , Leichliter JS , Aral SO . Sex Transm Dis 2012 39 (6) 458-64 BACKGROUND: The purpose of this study was to examine rates of 3 bacterial sexually transmitted diseases (STDs; syphilis, gonorrhea, and chlamydia) in 8 subpopulations (known as the "eight Americas") defined by race and a small number of county-level sociodemographic and geographical characteristics. The eight Americas are (1) Asians and Pacific Islanders in specific counties; (2) Northland low-income rural white; (3) Middle America; (4) Low-income whites in Appalachia and Mississippi Valley; (5) Western Native American; (6) Black middle America; (7) Southern low-income rural black; and (8) High-risk urban black. METHODS: A list of the counties comprising each of the eight Americas was obtained from the corresponding author of the original eight Americas project, which examined disparities in mortality rates across the eight Americas. Using county-level STD surveillance data, we calculated syphilis, gonorrhea, and chlamydia rates (new cases per 100,000) for each of the eight Americas. RESULTS: Reported STD rates varied substantially across the eight Americas. STD rates were generally lowest in Americas 1 and 2 and highest in Americas 6, 7, and 8. CONCLUSIONS: Although disparities in STDs across the eight Americas are generally similar to the well-established disparities in STDs across race/ethnicity, the grouping of counties into the eight Americas does offer additional insight into disparities in STDs in the United States. The high STD rates we found for black Middle America are consistent with the assertion that sexual networks and social factors are important drivers of racial disparities in STDs. |
Cost-effectiveness of a dual non-treponemal/treponemal syphilis point-of-care test to prevent adverse pregnancy outcomes in Sub-Saharan Africa
Owusu-Edusei K Jr , Gift TL , Ballard RC . Sex Transm Dis 2011 38 (11) 997-1003 BACKGROUND: A dual nontreponemal/treponemal point-of-care test (Dual-POC) that simultaneously detects both nontreponemal and treponemal antibodies has been developed and evaluated. In this study, we compare the health and economic outcomes of the new test with existing syphilis tests/testing algorithms in a high prevalence setting. METHODS: We used a cohort decision analysis model to examine 4 testing/screening algorithms; the Dual-POC test, the laboratory-based rapid plasma reagin and Treponema pallidum haemagglutination assay (RPR+TPHA) algorithm, an onsite RPR testing, and point-of-care treponemal immunochromatographic strip (ICS) testing. Outcomes included miscarriage, stillbirth, congenital syphilis, low birth weight, and neonatal death. Disability-adjusted life-years were estimated for all health outcomes. The analytic horizon was the life expectancy for the mother and child. RESULTS: For a cohort of 1000 pregnant women in a historically high syphilis prevalence population (10% infected and 15% previously infected), the model predicted a total of 39 adverse pregnancy outcomes if no serologic screening were performed; 13 for the laboratory-based RPR+TPHA; 11 for the on-site RPR strategy; 5 for the Dual-POC strategy; and 2 for the ICS strategy. On the basis of assumption that the cost of ICS and the Dual-POC tests were the same, the ICS strategy was the most cost saving (saved $30,000) followed by the Dual-POC strategy (saved $27,000). CONCLUSIONS: The dual-POC test may help save cost in resource-poor settings where disease prevalence (and loss to follow-up) is high, while substantially reducing overtreatment. |
County-level sexually transmitted disease detection and control in Texas: do sexually transmitted diseases and family planning clinics matter?
Owusu-Edusei K Jr , Doshi SR . Sex Transm Dis 2011 38 (10) 970-5 BACKGROUND: Sexually transmitted disease (STD) detection and control have traditionally been performed by STD and family planning (FP) clinics. However, the magnitude of their impact (or the lack thereof) has not been examined. We examine the association between having STD and/or FP clinics and county-level STD detection and control in the state of Texas. METHODS: We used county-level STD (chlamydia, gonorrhea, and primary and secondary syphilis) morbidity data from the National Electronic Telecommunications System for Surveillance for 2000 and 2007. We applied spatial regression techniques to examine the impact of the presence of STD/FP clinic(s) (included as dichotomous variables) on STD detection (i.e., morbidity) and control. We included county-level demographic characteristics as control variables. RESULTS: Our results indicated that counties with STD or FP clinics were associated with at least 8% (P < 0.05) increase in the transformed chlamydia and gonorrhea rates, 20% (P < 0.01) increase in transformed syphilis rates in 2000, and at least 6% (P < 0.05) increase in transformed gonorrhea and Chlamydia rates in 2007. From 2000 to 2007, the transformed incidence rates of chlamydia declined by 4% (P < 0.10), 8% (P < 0.01) for gonorrhea, and 8% (P < 0.05) for primary and secondary syphilis for the counties that had at least 1 STD or FP clinic. CONCLUSIONS: The results from this ecological study are associations and do not establish a causal relationship between having an STD/FP clinic and improved STD detection and control. Finer level analyses (such as census block or cities) may be able to provide more detail information. |
A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies
Chesson HW , Gift TL , Owusu-Edusei K Jr , Tao G , Johnson AP , Kent CK . Sex Transm Dis 2011 38 (10) 889-91 We conducted a literature review of studies of the economic burden of sexually transmitted diseases in the United States. The annual direct medical cost of sexually transmitted diseases (including human immunodeficiency virus) has been estimated to be $16.9 billion (range: $13.9-$23.0 billion) in 2010 US dollars. |
The tale of two serologic tests to screen for syphilis-treponemal and nontreponemal: does the order matter?
Owusu-Edusei K Jr , Koski KA , Ballard RC . Sex Transm Dis 2010 38 (5) 448-56 BACKGROUND: Standard syphilis screening involves an initial screening with a nontreponemal test and confirmation of positives with a treponemal test. However, some laboratories have reversed the order. There is no detailed quantitative and qualitative evaluation for the order of testing. In this study, we analyzed the health and economic outcomes of the order of testing for the 2 serologic tests used in syphilis screening under pure screening settings. METHODS: We used a cohort decision analysis to examine the health and economic outcomes of the screening algorithms for low and high prevalence settings. The 2-step algorithms were nontreponemal followed by treponemal (Nontrep-First) and treponemal followed by nontreponemal (Trep-First). We included the 1-step algorithms (treponemal only [Trep-Only] and an on-site nontreponemal only [Nontrep-Only]) for comparison. We estimated overtreatment rates and the number of confirmatory tests required for each algorithm. RESULTS: For a cohort of 10,000 individuals, our results indicated that the overtreatment rates were substantially higher (more than 3 times) for the 1-step algorithms, although they treated a higher number of cases (over 15%). The 2-step algorithms detected and treated the same number of individuals. Among the 2-step algorithms, the Nontrep-First was more cost-effective in the low prevalence setting ($1400 vs. $1500 per adverse outcome prevented) and more cost-saving ($102,000 vs. $84,000) in the high prevalence setting. CONCLUSIONS: The difference in cost was largely due to the substantially higher number of confirmatory tests required for the Trep-First algorithm, although the number of cases detected and treated was the same. |
The direct cost of chlamydial infections: estimates for the employer-sponsored privately insured population in the United States, 2003-2007
Owusu-Edusei K Jr , Doshi SR , Apt BS , Gift TL . Sex Transm Dis 2010 37 (8) 519-21 Claims data between 2003 and 2007 were used to estimate the direct medical cost per case of chlamydial infections. Estimated total cost per episode for those who were treated was $142 (male, $157; female, $141). This estimate does not include intangible cost, lost productivity, and the cost of potential sequelae. |
Treatment cost of acute gonococcal infections: estimates from employer-sponsored private insurance claims data in the United States, 2003-2007
Owusu-Edusei K Jr , Gift TL , Chesson HW . Sex Transm Dis 2010 37 (5) 316-8 We used 2003-2007 claims data to estimate the direct cost of medical care per case of acute gonorrhea infection. The estimated average total cost per episode for those who were treated was $210 (male, $227; female, $205). This estimate does not include intangible (e.g., pain) and indirect costs (e.g., lost productivity). |
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