this estimate does not include costs associated with newly described STD-related syndromes such as premature delivery in pregnant women and low birth weight associated with bacterial vaginosis. Comprehensive and accurate data regarding the economic costs of STDs are essential for cost-effectiveness analyses of prevention programs, but cost and morbidity data are not currently available for many STDs and related syndromes. Therefore, the CDC or other appropriate federal agency should conduct or support a comprehensive analysis of the economic consequences of STDs and associated sequelae. This analysis should include estimates of direct and indirect costs and appropriate cost-benefit and cost-effectiveness analyses of interventions.

The current national response to STDs is not commensurate with their health and economic costs. STDs are a formidable health problem and should be a national public health priority. An effective national system requires additional investment to avert the much higher long-term costs of STDs. Current public resources allocated for STD prevention are extremely low. As discussed in Chapter 5, the committee estimates that only $1 is invested in STD prevention for every $43 spent on the costs of STDs and their complications every year. Similarly, only $1 is invested in biomedical and clinical research for every $94 spent on the costs of STDs. Studies cited in Chapter 4 show that STD prevention efforts are cost-effective and sometimes cost-saving. Investing in preventive services will avert substantial human suffering and save billions of dollars in treatment costs that result from the costly complications of STDs and lost productivity. The CDC estimates that for every $1 spent on early detection and treatment of chlamydial and gonococcal infection, approximately $12 in associated costs could be saved (CDC, DSTD/HIVP, 1995).

There is a widespread belief among clinicians and researchers who work in STDs that the social and economic costs of STDs in the United States justify expenditures of much more money and effort than currently are devoted to this area. This type of statement often is made for many types of prevention, but the committee is of the opinion that the situation is worse in STDs than in many other areas. The committee also recognizes, however, that devoting resources to prevention programs is not always cost-effective (Russell, 1994). Unfortunately, there is surprisingly little data either on absolute expenditures for STD prevention or the cost-effectiveness of different types of expenditures. Thus, the committee recommends that rigorous analyses of the cost-effectiveness of different types of prevention programs be conducted. This kind of research should be supported by the National Institutes of Health, the Agency for Health Care Policy and Research, and other agencies.

The committee recognizes that establishing a national system for STD prevention requires additional funding and that this may be very difficult in an era of shrinking federal and state budgets. The committee proposes that additional funding to establish a national system for STD prevention come from all levels of government and the private sector. Regardless of whether additional funds can be

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