Estimating the Total Annual Direct Cost of Universal STI Screening for MSM in the United States

Background:  Recent estimates of the burden of sexually transmitted infections (STI) show that men who have sex with men (MSM) have a higher burden than the general population. Because of their greater risk of infection, CDC recommends STI screening of sexually active MSM at least annually. We sought to estimate the annual direct medical cost of providing recommended STI screening for all MSM in the United States (US).

Methods:  We included costs for eight STI tests recommended by CDC (HIV, syphilis, gonorrhea (urethral, rectal and pharyngeal), chlamydia (urethral and rectal) and HSV-2) and office visit. All cost data were obtained from the MarketScan commercial insurance claims database for 2012, which was released in early 2014.  Men were defined as MSM if they had a male sex partner within the last 12 months.  Based on a recent study, 2.9% (2.6%-3.2%) of men in the US were presumed to be MSM. Population estimates for males aged 15-64 years were obtained from the Census Bureau. Total costs were calculated for all MSM (all races/ethnicities), non-Hispanic black MSM and Hispanic MSM. All costs were in 2012 US dollars.

Results:  We estimated that the total annual direct cost per person was $309 (range, $285 - $366). The total cost for all MSM was $937 million (range, $774 million - $1.2 billion); non-Hispanic black MSM, 97 million (range, $118 million – $154 million); Hispanic MSM, $137 million (range, $166 million – $216 million).

Conclusions:  These estimates do not include cost of other preventive services that may be relevant for MSM (such as behavioral counselling). However, they provide the potential costs associated with STI screening for MSM that can help guide decision making and identify resources needed to provide recommended services. More studies are needed to quantify the potential impact of annual STI screening on the overall burden of STIs among MSM.