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Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia

Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia,10.1136/sti.2009.036673,Archives of Disease in Childhood,D

Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia   (Citations: 4)
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ObjectivesCommercial sex is licensed in Victoria, Australia such that sex workers are required to have regular tests for sexually transmitted infections (STIs). However, the incidence and prevalence of STIs in sex workers are very low, especially since there is almost universal condom use at work. We aimed to conduct a cost-effectiveness analysis of the financial cost of the testing policy versus the health benefits of averting the transmission of HIV, syphilis, chlamydia and gonorrhoea to clients.MethodsWe developed a simple mathematical transmission model, informed by conservative parameter estimates from all available data, linked to a cost-effectiveness analysis.ResultsWe estimated that under current testing rates, it costs over $A90 000 in screening costs for every chlamydia infection averted (and $A600 000 in screening costs for each quality-adjusted life year (QALY) saved) and over $A4 000 000 for every HIV infection averted ($A10 000 000 in screening costs for each QALY saved). At an assumed willingness to pay of $A50 000 per QALY gained, HIV testing should not be conducted less than approximately every 40 weeks and chlamydia testing approximately once per year; in comparison, current requirements are testing every 12 weeks for HIV and every 4 weeks for chlamydia.ConclusionsMandatory screening of female sex workers at current testing frequencies is not cost-effective for the prevention of disease in their male clients. The current testing rate required of sex workers in Victoria is excessive. Screening intervals for sex workers should be based on local STI epidemiology and not locked by legislation.
Journal: Archives of Disease in Childhood - ARCH DIS CHILD , vol. 86, no. 2, pp. 117-125, 2009
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    • ...former Editor and an eminent authority in this field. The regulation of sex work, through health or policing regulations, goes back to the roots of our clinical and academic disciplines, and perverse consequences endlessly emerge from well-meaning initiatives. Only last year we published an Australian study which demonstrated the waste of resources—and displacement of needy patients—resulting from regulations requiring frequent checkups for sex workers....

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