The Hidden Epidemic Confronting Sexually Transmitted Diseases (1997) / Chapter Skim
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APPENDIX D
APPENDIX D
Pages 330-356
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From page 330... ...
These are gonorrhea, chlamydial infection, syphilis, genital herpes, human papillomavirus (HPV) , chancroid, and hepatitis B virus infection.
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From page 331... ...
The economic burden of a disease can be demonstrated by calculating either its prevalent costs (the annual costs of cases prevalent during a given year) or the lifetime costs of individual cases (incident costs)
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Annual spending may reflect a minor or a major proportion of the total expenditures related to an illness. In the early 1980s, for example, annual costs for HIV infection represented only a very small part of the costs eventually attributable to existing infection.
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A problem common to cost estimates of a range of diseases is that treatment patterns and costs vary geographically and by care setting. Studies using a variety of data sets would be required to accurately assess the distribution of costs.
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From page 334... ...
The following headings were used as keywords in both titles and abstracts: cervical cancer, cost and cost analysis, chlamydia, chancroid, economics, genital herpes, gonorrhea, health expenditures, herpes simplex, hepatitis B human papillomavirus, pregnancy, sexually transmitted diseases, and syphilis.
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From page 335... ...
Many of the estimates in the literature ales from the early 1980s, which were higher in many cases cidence rates. In adjusting overall cost estimates for current ?
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From page 336... ...
These studies are useful building blocks for estimates of overall economic burden. Finally, there are cost-effectiveness and cost-benefit studies, often termed "economic evaluations." These studies are of limited use in assessing economic burden, although they may contain information relevant to calculating annual costs.
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From page 337... ...
Annual costs are cited, with the exception of those associated with CNS impairment, which are available in the report. However, the cost estimates for CNS impairment use total costs per case rather use costs on an annualized basis.
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From page 338... ...
It accounted for neither costs of stillbirths resulting from congenital syphilis nor annual costs associated with long-term disability after the first year of life. The authors tested their model for sensitivity to the assumptions contained in the model, reporting that the cost estimates were significantly sensitive to the assumed severity of cases.
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From page 339... ...
Data for outpatient visits were obtained From the National Ambulatory Medical Care Survey for the earlier study and From the National Disease Therapeutic Index for the later study. Both studies Used the National Health Survey of Physician Visits to estimate costs of clinic and emergency room visits.
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From page 341... ...
It was conducted for the purpose of demonstrating the excess cost associated with cesarean sections, given evidence of a low attack rate for women with recurrent HSV, who comprise the majority of women undergoing cesarean sections for genital herpes. The analysis is model-based.
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From page 342... ...
Treatment Other GonorrheaC 1,980 Chlamydial infections 1,350 PIDc Syphilis Congenital Herpes Simplex 178 Neonatal HSV HPV Chancroid Hepatitis B virus infection 791-1,050 668-1,510 3,560 3,120 16.1 10.1-12.4 Cervical cancere 791 396-712 72.9-96.4 35.8-67.0 10.5 (first year treatment) 0.066 (drug treatment)
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From page 343... ...
. Global Cost Estimates.
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The incremental cost of screening, diagnosis, and treatment of gonorrhea and chlamydia in a family planning clinic. Sex Transm Dis 1989;16:63-7.
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Assuming, as Washington and Katz did, that initial visits occur in clinics and hospital emergency rooms twice as often as in private offices, these data suggest 1,160,580 total initial visits for PID. There were 51,687 hospitalizations for ectopic pregnancy in 1993 (CDC, DSTDP, 1995)
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From page 346... ...
, which was the basis for an overall cost estimate for chlamydia of $727 million in direct costs (1985$~. This estimate includes costs for an estimated 73,800 cases of conjunctivitis and 37,100 cases of TABLE D-5 Calculation of 1,765,539 Cases of Chlamydial Infection Using Estimates of Gonorrhea Incidence 1.
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From page 347... ...
In a model of congenital syphilis costs, de Lissovoy and others (1995) assigned a treatment protocol to patients as a function of the estimated level of the severity of illness.
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From page 348... ...
In 1993, estimates based on data from the National Disease and Therapeutic Index (NDTI) indicated that there were 171,565 initial visits to private physicians' offices for genital herpes (IMS America, 1993; CDC, DSTDP, 1995~.
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From page 349... ...
Primary genital Severity A Severity B Recurrent genital Neonatal HSV Neonatal HSV Mild CNS impairment Serious CNS impairment Very severe CNS impairment Cultures during pregnancy Cesarean sections 5,680,000 5,287,000 25,581,000 7,156,000 702,000 1,495,000 15,982,000 5,391,000 17,250,000 Total 84,524,000 (1984$) (178.3 million [1994$]
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From page 350... ...
Thus, in 1994, total annual costs of neonatal HSV would have been an estimated $13.00 million (1994$~. Human Papillomavirus (HP V)
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From page 351... ...
Some reviews are more cautious in their assessment of the causative role of this specific agent, noting that epidemiologic evidence does not yet support the theoretical link between HPV and cervical cancer (Reeves et al., 1989; Oriel, 1990; Paavonen et al., 1990~. However, there is less reservation about the link between sexually transmitted diseases generally and cervical cancer.
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From page 352... ...
However, this estimate precedes HIV infection and does not include cervical cancer (Grimes, 1986~. Indirect costs reflect the quantification of health effects both morbidity and mortality in terms of their monetary value.
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However, it can also be argued that the use of genderspecific wages for women, because they are lower than those of men, undervalues the economic burden (Curran, 1980~. CONCLUSIONS The cost estimates reviewed here demonstrate the limited amount of research that has been conducted to quantify the current annual economic burden imposed on society by sexually transmitted diseases.
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From page 354... ...
. 1993 Sexually transmitted diseases treatment guidelines.
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From page 355... ...
Deaths due to sexually transmitted diseases: the forgotten component of reproductive mortality.
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From page 356... ...
Sexually transmitted diseases.
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Key Terms
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