Targeted versus Universally Offered Screening in Pediatric Emergency Departments: Cost-Effectiveness
Mark H. Eckman, Monika K. Goyal, T. Charles Casper, Chella Palmer, Jennifer L. ReedBackground:
Adolescents and young adults (AYA) comprise 50% of sexually transmitted infections (STIs) diagnosed annually. AYA frequently access emergency departments (EDs) for health care. Thus, the ED could be a strategic venue for the diagnosis and treatment of STIs.
Objective:
Cost-effectiveness analysis examining screening strategies for
Design:
Decision analytic cost-effectiveness model.
Setting:
Six pediatric EDs.
Participants:
AYA 15 to 21 y of age seeking acute care at pediatric EDs.
Interventions:
1) Usual care, 2) targeted screening (using a computerized sexual health survey), and 3) universally offered screening.
Main Outcomes and Measures:
Cost in 2024 US dollars and effectiveness measured as STIs detected and successfully treated. Secondary effectiveness outcome metric: quality-adjusted life-years (QALYs). The cost perspective is the direct health care sector, and the time horizon is lifelong.
Results:
Targeted screening was the most effective and most costly (incremental cost-effectiveness ratio [ICER] of $517 per case detected and successfully treated). In a secondary analysis using QALYs lost for long-term complications of untreated CT/GC, targeted screening had an ICER of $23,320/QALY. In this analysis, usual care was dominated, being more costly and less effective than universally offered screening. In subgroup analyses of female versus male, only cohorts using $/QALY, targeted screening remained highly cost-effective for females ($6,389/QALY) compared with universally offered screening but was not cost-effective in males.
Conclusions and Relevance:
Targeted screening is a highly cost-effective strategy for detecting and treating STIs in adolescents seeking pediatric ED care compared with universally offered screening, with an ICER of $517 per case detected and treated. When considering quality of life for female- versus male-only subgroups, screening for males becomes less clear.