While the substantial morbidity caused by STDs is now being more widely recognized, little attention has been paid to what they cost. Limited resources and current competing health care needs, however, are forcing consideration of the economic consequences of STDs as a pivotal criterion for determining the relative urgency of this problem. By this measure also, STDs rank as a formidable health problem.

The economic burden of STDs is associated with both direct and indirect cost. Direct costs refer to expenditures for health care and represent the value of goods and services that actually were used to treat STDs or associated sequelae. These direct health care expenditures may be for either medical or nonmedical services and materials. Examples of STD-related direct costs include costs for health professionals' services (i.e., physicians, nurses, and technicians), costs of laboratory services, and cost of hospitalizations for STD (i.e., hospital accommodations and operating room). Resources used for transportation, residential care, special education, and other similar purposes are also considered direct costs. In contrast, indirect costs refer to lost productivity and represent the value of output forgone by individuals with STDs and associated disability. Indirect costs include these lost wages due to not working and/or value of household management that is not performed because of STD-related illnesses. Lost wages due to premature deaths are also considered indirect costs.

The costs of a few STDs have been estimated (IOM, 1985; Washington et al., 1987; Washington and Katz, 1991), but no comprehensive, current analysis of the direct and indirect costs of STDs is available. Such information is vital to accurately depict the full magnitude of the STD problem. Moreover, only with complete STD cost data can the true benefits of investments in STD prevention be assessed. Therefore, the committee commissioned a paper to provide the basis for estimating the economic burden of STDs. Results from this analysis (conducted by Joanna Siegel at the Harvard School of Public Health) are summarized below (Table 2-5) and described in more detail in Appendix D.

Total costs for a selected group of common STDs and related syndromes are estimated to be approximately $10 billion in 1994 dollars (Table 2-5). Important to note is that this rough, conservative estimate does not capture the economic consequences of several other STDs and associated syndromes such as vaginal bacteriosis, trichomoniasis, nongonococcal urethritis, mucopurulent cervicitis, lymphogranuloma venereum, molluscum contagiosum, scabies, and pediculosis pubis. Nor does this estimate include the annual cost of sexually transmitted HIV/AIDS-related illness, which is estimated to be $6.7 billion (Table 2-5). Inclusion of these costs raises the overall cost of sexually transmitted illnesses in the United

FRONT MATTER (R1-R14)

EXECUTIVE SUMMARY (1-18)

INTRODUCTION AND BACKGROUND (19-27)

THE NEGLECTED HEALTH AND ECONOMIC IMPACT OF STDs (28-68)

FACTORS THAT CONTRIBUTE TO THE HIDDEN EPIDEMIC (69-117)

PREVENTION OF STDs (118-174)

CURRENT STD-RELATED SERVICES (175-219)

ESTABLISHING AN EFFECTIVE NATIONAL SYSTEM TO PREVENT STDs (220-302)

APPENDIX A (303-310)

APPENDIX B (311-315)

APPENDIX C (316-329)

APPENDIX D (330-356)

APPENDIX E (357-362)

APPENDIX F (363-369)

APPENDIX G (370-382)

APPENDIX H (383-393)

APPENDIX I (394-399)

APPENDIX J (400-410)

INDEX (411-432)