{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T08:44:04Z","timestamp":1782981844772,"version":"3.54.5"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD094213"],"award-info":[{"award-number":["R01HD094213"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"health resources and services administration","doi-asserted-by":"publisher","award":["UJ5MC30824, U03MC28844, U03MC22684, U03MC00007, U03MC00001, U03MC33154, U03MC33156, U03MC33155"],"award-info":[{"award-number":["UJ5MC30824, U03MC28844, U03MC22684, U03MC00007, U03MC00001, U03MC33154, U03MC33156, U03MC33155"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["MDM Policy &amp; Practice"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Adolescents and young adults (AYA) comprise 50% of sexually transmitted infections (STIs) diagnosed annually. AYA frequently access emergency departments (EDs) for health care. Thus, the ED could be a strategic venue for the diagnosis and treatment of STIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      Cost-effectiveness analysis examining screening strategies for\n                      <jats:italic toggle=\"yes\">Chlamydia trachomatis<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Neisseria gonorrhea<\/jats:italic>\n                      (CT\/GC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Decision analytic cost-effectiveness model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Six pediatric EDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>AYA 15 to 21\u2009y of age seeking acute care at pediatric EDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>1) Usual care, 2) targeted screening (using a computerized sexual health survey), and 3) universally offered screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures:<\/jats:title>\n                    <jats:p>Cost in 2024 US dollars and effectiveness measured as STIs detected and successfully treated. Secondary effectiveness outcome metric: quality-adjusted life-years (QALYs). The cost perspective is the direct health care sector, and the time horizon is lifelong.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Targeted screening was the most effective and most costly (incremental cost-effectiveness ratio [ICER] of $517\u2009per case detected and successfully treated). In a secondary analysis using QALYs lost for long-term complications of untreated CT\/GC, targeted screening had an ICER of $23,320\/QALY. In this analysis, usual care was dominated, being more costly and less effective than universally offered screening. In subgroup analyses of female versus male, only cohorts using $\/QALY, targeted screening remained highly cost-effective for females ($6,389\/QALY) compared with universally offered screening but was not cost-effective in males.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance:<\/jats:title>\n                    <jats:p>Targeted screening is a highly cost-effective strategy for detecting and treating STIs in adolescents seeking pediatric ED care compared with universally offered screening, with an ICER of $517\u2009per case detected and treated. When considering quality of life for female- versus male-only subgroups, screening for males becomes less clear.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23814683261460886","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:29:53Z","timestamp":1782818993000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeted versus Universally Offered Screening in Pediatric Emergency Departments: Cost-Effectiveness"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8253-269X","authenticated-orcid":false,"given":"Mark H.","family":"Eckman","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika K.","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s National Hospital, The George Washington University, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Charles","family":"Casper","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chella","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Reed","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Cincinnati Children\u2019s Hospital Medical Center and The Department of Pediatrics, The University of Cincinnati College of Medicine, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention; 2020. 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