CBA Table

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CBA Table
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    Current   Status (Symptomatic STD Screening and Treatment)   Under Proposed Intervention (Asymptomatic STD Screening and Treatment)   Extra Dollars Saved (Benefits)   Costs Associated with Sexually Transmitted Diseases   Number of Patients with STI Screening 1  1260 8400 Cost per STD Screening 2  1260*$31.68 = $39,916.80 8400*$31.68 = $266,112.00  Number of Patients with Positive STD Screening Results 3, 4  1008 1260 Percent of Patients with Positive STI Screening Receiving Treatment 5  80% 80%  Number of Patients Treated 4, 5  806 1008 Cost per STD Treatment 806*$27.68 = $22,310.08 1008*$27.68 = $27,901.44 Sequelae costs averted by treatment of people with chlamydia, gonorrhea, and syphilis   7, 8, 9, 10 80 PID cases averted * $1995 = $159,600 100 PID cases averted*$1995 = $199,500 $39,900 1 Epididymitis case averted*$274 = $274 2 Epididymitis cases averted * $274 = $548 $274  Neurovascular/Cardiovascular Syphilis case averted * $572 = $572 2  Neurovascular/Cardiovascular Syphilis case averted * $572 = $1144 Treatment and sequelae costs averted by reducing transmission of chlamydia, gonorrhea, and syphilis   8, 9, 10, 11 604 females treated * $315 transmission averted cost = $190,260 202 males treated * $26 transmission averted cost = $5,252.00 806 females treated * $315 transmission averted cost = $253, 890 252 males treated * $26 transmission averted cost = $6,552.00 $63, 630 $1300   604 females treated * $343 transmission averted cost = $207,172 202 males treated * $ 68 transmission averted cost = $13, 736.00 806 females treated * $343 transmission averted cost = $276, 458 252 males treated * $ 68 transmission averted cost = $17, 136.00 $69,286 $3400   1 cases treated * $572.00 transmission averted cost = $572.00 2 cases treated * $572.00 transmission averted cost = $1144.00 $572 Total Extra Dollars Saved $ 178, 362 Total Costs $62,226.88 $294,013.44 Expected Reimbursement (80%) 12  $49781.50 $235,210.75  Net costs: $12, 445.38 Net costs: $58, 802.69 (Extra Dollars Spent for More Screening and Treatment)$46,357.31   Net Savings $178, 362 -$46,357.31 = $132,004.69 Direct Program Costs  RN Training 13  $825.75 MD/NP/PA Training 14  $1, 995 Patient Education Materials 15  $2,392.78 Administrative Costs 16  $21, 195.01 Total Program Costs  $26, 408.54 Cost- Benefit ratio   Net Savings ($132,004.69) / Total Program Costs ($26,408.54) = 4.99 Therefore, for every dollar spent in the new program, $ 4.99 is saved.   1 - Estimate based on RUMC’s  70,000 ED visits in 2015. Under proposed intervention, 15% are meeting inclusion criteria for STD screening (age/sexual behavior/pregnancy status) and 80% consenting to do STD screening. Current status is estimated based on US Survey (Hollander, 2016) that only 12% of the adolescents and young adult have had an STD screening due to having symptoms 2- Silva et al (2007) states the STD Test costs in a similar study as $27.37 per person. Screening costs is adjusted for 2017-dollar value at $31.68 at 15.38% inflation rate 3- Under the proposed intervention, an estimate of 15% of asymptomatic STD positive screening in the ED setting is assumed as provided on literature review from by Schneider, Fitzgerald, Byczkowski, & Reed (2016). 4  –   Patients who present to ED with STD symptoms are empirically treated (approximately 80%). 5 - An estimate of 20% will not receive treatment due to  patient’s  decision or for other instances such as when provider is unable to reach patient on follow-up calls (Schneider, Fitzgerald, Byczkowski, & Reed (2016).) 6 - Silva et al (2007) states the STD Treatment costs in a similar study as $23.91 per person. Treatment costs is adjusted for 2017-dollar value at $27.68 at 15.80% inflation rate. 7 Sequelae costs averted by treatment of people with chlamydia, gonorrhea, and syphilis: Chesson et al. (2008) estimates $1,995 as the direct medical cost per case of Pelvic Inflammatory Disease, $572 direct medical cost for possibility of neurosyphilis and cardiovascular syphilis in untreated syphilis cases and $274 as the direct medical cost per case of epididymitis. 8 - Symptomatic PID occurs in about 10 to 15 percent of women with untreated chlamydia (CDC, 2016) 9 - CDC (2016) reports there is approximately 1 male infected with STD for every 3 females infected in 15-24 age group;1 man out of every 144 men (0.69 percent) in US is affected with Epididymitis related to STDs 10 - In Cook County, IL the syphilis infection rate is 17.4 per 100,000 (CDC, 2016) 11 - Treatment and sequelae costs averted by reducing transmission of chlamydia, gonorrhea, and syphilis. Chesson et al. (2008) estimates these costs as follows: $315 and $26 for chlamydia in women and men, respectively; $343 and $68 for gonorrhea in women and men, respectively, and $572 for syphilis in men and women. 12  –   HealthCare.Gov (2016) states that a common reimbursement percentage is 80%.  13 - Per glassdoor.com, Rush RN average salary is $33.03. If 30 minutes is spent on training nurses to implement this program, training 50 nurses in the ED would cost $825.75 14 - According to beckershospitalreview.com, emergency medicine providers earn an average of $133 hourly. If 30 minutes is spent on training ED providers to implement this program, training 30 providers in the ED would cost $1, 995. 15 - Silva et al (2007) estimates patient education materials costs at $2000 which was adjusted to 2017-dollar value of $2,392.78 at 1.81% inflation. 16 Silva et al (2007) In their similar study estimates $17,716 as administrative costs (obtaining informed consent, delivering positive test results, and referring patients for treatment. This amount is adjusted to 2017-dollar value of 21, 195.29 at 1.81% inflation.
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