SEXUALLY TRANSMITTED DISEASES AND COUNSELING: AN ECONOMIC EVALUATION

Sexually transmitted diseases (STDs) are among the most important diseases, with annual incidence of about 20 million cases, that impact the public health in the USA.1,2 There are several health education preventive strategies. Kamb et al studied 3 different interventions: didactic messages, brief and enhanced counseling. We analyzed the cost-effectiveness of those 3 intervention strategies using the original Kambs data and new data from the state of Georgia with different intervention effectiveness and completion rates.3We looked at the state prospective. We computed the results based on the incremental cost-effectiveness ratio (ICER), built our decision tree usingTreeAgesoftware assuming some variables that are not available in the literatures and conducted sensitivity analyses for some variables.Based on the ICER, when using the Kambs data we found that the brief counseling dominates both enhanced counseling and didactic messages. However, when we increase either one of the effectiveness or the intervention completion rates alone for the enhanced counseling, or when we increase both of them simultaneously, there was no dominant strategy.Sensitivity analyses showed that the enhanced counseling strategy became optimal if the intervention completion rates exceeded 72% or the incidence rate was less than 11.5%.From an economic point of view, we concluded by recommending against routine use of the enhanced counseling program for STDs high-risk populationsthat are not expected to complete all the counseling sessions. On the other hand, we encourage utilizing the brief counseling strategy for moderate to high-risk populations with higher probability of drops out from the program. It should substitute the current practice of didactic messages.The policy makers may consider other non-economic factors to complete the view before putting these recommendations in play.