We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006–2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90–180 days and 181–395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of $30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2010. Atlanta, GA: Department of Health and Human Services, 2011
2.
ChessonHWBlandfordJMGiftTLTaoGIrwinKL. The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspect Sex Reprod Health2004;36:11–9
3.
HillisSDOwensLMMarchbanksPAAmsterdamLFMacKenzieWR. Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease. Am J Obstet Gynecol1997;176:103–7
4.
FlemingDTWasserheitJN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect1999;75:3–17
5.
Centers for Disease Control and Prevention. Sexually Transmitted Disease Treatment Guideline, 2010. MMWR2010;59:1–110
6.
American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. ACOG Committee Opinion #301: Sexually transmitted diseases in adolescents. Obstet Gynecol2004;104:891–8
7.
U.S. Preventive Services Task Force. Screening for chlamydial infection: recommendation statement. Ann Intern Med2007;147:128–34
8.
HosenfeldCBWorkowskiKABermanSRepeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis2009;36:478–89
9.
MolanoMMeijerCJWeiderpassEThe natural course of Chlamydia trachomatis infection in asymptomatic Colombian women: a 5-year follow-up study. J Infect Dis2005;191:907–16
10.
MosherWDChandraAJonesJ. Sexual behavior and selected health measures: men and women 15–44 years of age, United States, 2002. Adv Data2005;15:1–55
11.
MillerWCFordCAMorrisMPrevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA2004;291:2229–36
12.
ParkIUAmeyACreeganLBarandasABauerHM. Retesting for repeat chlamydial infection: family planning provider knowledge, attitudes, and practices. J Womens Health (Larchmt)2010;19:1139–44
13.
HeijneJCTaoGKentCKLowN. Uptake of regular chlamydia testing by U.S. women: a longitudinal study. Am J Prev Med2010;39:243–50
14.
JoesoefMRWeinstockHSJohnsonRE. Factors associated with recurrent chlamydial infection and failure to return for retesting in young women entering national job training program, 1998–2005. Sex Transm Dis2008;35:368–71
15.
BernsteinKTZenilmanJOlthoffGMarsigliaVCErbeldingEJ. Gonorrhea reinfection among sexually transmitted disease clinic attendees in Baltimore, Maryland. Sex Transm Dis2006;33:80–6
16.
MalotteCKLedskyRHogbenMComparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics. Sex Transm Dis2004;31:637–42
17.
Dukers-MuijrersNHvan LiereGAHoebeCJ. Re-screening Chlamydia trachomatis positive subjects: a comparison of practices between an STI clinic, general practitioners and gynaecologists. Sex Transm Infect2013;89(1):25–27
18.
Hock-LongLHerceg-BaronRCassidyAMWhittakerPG. Access to adolescent reproductive health services: financial and structural barriers to care. Perspect Sex Reprod Health2003;35:144–7
19.
RietmeijerCAAlfonsiGADouglasJMLloydLVRichardsonDBJudsonFN. Trends in clinic visits and diagnosed Chlamydia trachomatis and Neisseria gonorrhoeae infections after the introduction of a copayment in a sexually transmitted infection clinic. Sex Transm Dis2005;32:243–6
20.
HenryJ. Kaiser Family Foundation. Summary of New Health Reform Law. See http://www.kff.org/healthreform/upload/8061.pdf (last checked 23 September 2012)
21.
National Committee for Quality Assurance (NCQA). HEDIS & Quality Measurement. See http://www.ncqa.org/tabid/59/Default.aspx (last checked 23 September 2012)
22.
MorrowRWGoodingADClarkC. Improving physicians’ preventive health care behavior through peer review and financial incentives. Arch Fam Med1995;4:165–9
23.
KambMLRhodesFHoxworthTWhat about money? Effect of small monetary incentives on enrollment, retention, and motivation to change behaviour in an HIV/STD prevention counselling intervention. The Project RESPECT Study Group. Sex Transm Infect1998;74:253–5
24.
TalbotM. Monetary incentives in research and participation in HIV/STD risk reduction programmes. Sex Transm Infect1999;75:1–2
25.
CurrieMJSchmidtMDavisBK‘Show me the money’: financial incentives increase chlamydia screening rates among tertiary students: a pilot study. Sex Health2010;7:60–5
26.
KissingerPKopickoJJMyersLThe effect of modest monetary incentives on follow-up rates in sexually transmitted disease studies. Int J STD AIDS2000;11:27–30
27.
HodgeBJMartinM. Benefit design critical to protecting out-of-pocket costs for employees. Am J Manag Care2008;14:S246–51
28.
Scott LamontagneDBasterKEmmettLIncidence and reinfection rates of genital chlamydial infection among women aged 16–24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group. Sex Transm Infect2007;83:292–303
29.
HwangLYTebbKPShaferMAPantellRH. Examination of the treatment and follow-up care for adolescents who test positive for Chlamydia trachomatis infection. Arch Pediatr Adolesc Med2005;159:1162–6
30.
McAlearneyASReevesKWTatumCPaskettED. Cost as a barrier to screening mammography among underserved women. Ethn Health2007;12:189–203
31.
PignoneMBucholtzDHarrisR. Patient preferences for colon cancer screening. J Gen Intern Med1999;14:432–7
32.
GuyRHockingJLowNInterventions to increase rescreening for repeat chlamydial infection. Sex Transm Dis2012;39:136–46
33.
MorganJWoodhallS. Repeat chlamydia testing across a New Zealand district: 3 years of laboratory data. Sex Transm Infect2013;89(1):28–31
34.
SparksRHelmersJRHandsfieldHHRescreening for gonorrhea and chlamydial infection through the mail: a randomized trial. Sex Transm Dis2004;31:113–6
35.
GrahamV. Evaluating the efficacy of a rescreening intervention among individuals previously infected with Chlamydia. Thesis, California State University, Fullerton, 2009
