The estimated direct medical cost of sexually transmitted diseases among American youth, 2000

Perspectives on Sexual and Reproductive Health, Jan-Feb, 2004 by Harrell W. Chesson, John M. Blandford, Thomas L. Gift, Guoyu Tao, Kathleen L. Irwin

Our cost estimates did not include either the indirect costs or the intangible costs associated with STDs; the estimated burden of STDs would be substantially higher if these costs were included. Even though we included eight major STDs, we excluded other important STDs, such as hepatitis C, human cytomegalovirus and bacterial vaginosis, because of limited cost information. We did not include the cost of genital herpes attributable to HSV-1.

These numerous limitations likely result in an underestimation of the cost of STDs among adolescents and young adults. If we included every known STD and every possible associated cost, the estimated cost burden of STDs would be greater. Furthermore, the estimated cost would be about 10% higher if expressed in current dollars rather than year 2000 dollars. And prevalence costs of STDs could be even higher than the incidence costs we estimated here, because prevalence costs include current costs of STDs acquired in previous years and are not discounted.

Our analysis provides only point estimates of the cost of eight major STDs. Although this is an important first step in examining the cost of STDs among adolescents, more research is needed. Most important, future studies should include detailed sensitivity analyses to examine how the cost-per-case estimates change when key inputs (cost of treatment, probability of long-term sequelae, etc.) are varied. Incorporating sensitivity analyses was beyond the scope of this study, and any subsequent users of the point estimates we have provided should address the inherent uncertainty in these estimates.

Despite its limitations, our cost analysis provides practical estimates of the direct medical costs of STDs among America's youth. These figures underscore the enormous burden of STDs and illustrate the potential savings that could be achieved through successful STD prevention activities.

Acknowledgments

The authors thank J. Thomas Cox, Eileen Dunne, David N. Fisman, Sue J. Goldie, Shalini Kulasingam, Herschel W. Lawson, Evan Myers, Katherine M. Stone, James Trussell and Hillard Weinstock for helpful suggestions and additional information. We are also grateful for recommendations and comments from the following members of the University of North Carolina School of Journalism and Mass Communication Panel on Youth, Sexually Transmitted Discases and the Media, which was supported by the William T. Grant Foundation: Tracey A. Adams, Jane D. Brown, Virginia Caine, Joan R. Cates, Willard Cates, Jr., Richard A. Crosby, Jacqueline E. Darroch, Ralph DiClemente, Nancy Herndon, Lloyd J. Kolbe, Felicia E. Mebane, Susan L. Rosenthal, Laura F. Salazar, Susan Schulz, Jonathan Stacks and Felicia Stewart.

* Other medical costs that may be attributable to HPV infection--such as those associated with cancers of the anus, penis, vulva and vagina--are not included, because the proportion of these cancers that may be attributed to HPV has not been well established.

([dagger)] We used this approach because of the high rate of clearance of incident HPV infection without treatment and the difficulty of predicting the likelihood of progression from incident infection to particular manifestations of disease (sources: Ho GY et al., Natural history of cervicovaginal papillomavirus infection in young women, New England Journal of Medicine, 1998, 338(7):423-428; Moscicki AB et al., The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women, Journal of Pediotrics, 1998, 132(2):277-284; and Woodman CB et al., Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study, Lancet, 2001, 357(9271):1831-1836).