A Comparison of the Case-Finding Effectiveness and Average Costs of Screening and Partner Notification

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Abstract
Sexually transmitted disease control programs rely on case-finding through screening and partner notification to control syphilis. Difficulty in controlling recent syphilis epidemics have raised questions about the effectiveness of these strategies. This study sought to evaluate the contributions of screening and field epidemiology to case-finding and compare average costs of these methods. The study was designed as a descriptive study of outcomes in a cohort tested for syphilis through a county health department. Cost-effectiveness analysis using average costs per outcome were used. Testing self-motivated individuals accounted for 85% of the case-finding. Testing was more cost-effective than Disease Intervention Specialist activity when measured as cost per new case. Testing and Disease Intervention Specialist activity were comparable in cost when measured in terms of a Weighted Disease Intervention Index. Sexually transmitted disease control programs must consider how to balance investments in screening and DIS field intervention. Programs also should reevaluate their approach to control of epidemic syphilis in light of the limited effectiveness of traditional control strategies.