MONTREAL — Expedited partner treatment, also known as patient-delivered partner therapy, could substantially reduce costs and morbidity from sexually transmitted diseases if it were allowed in all states, according to Dr. Margaret Villers.
The practice allows physicians who are treating patients with sexually transmitted diseases to either provide treatment, or write a prescription for their patients' partners without requiring the partners to come into the office.
Although the Centers for Disease Control and Prevention has encouraged expedited partner treatment (EPT) since 2006, it is explicitly legal in only 19 states, and “in multiple states and localities, there are legal barriers which may prevent universal implementation,” Dr. Villers said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. (For a map showing the legal status of EPT in each state, visit www.cdc.gov/std/ept/legal/default.htm
“The South Carolina statute very much mirrors the other states where it's prohibited in the sense that if you do not see a patient—if you've never met them, if you have not examined them, and if you do not have an ongoing relationship with them—then you are not allowed to prescribe a medication for them,” explained Dr. Villers of the Medical University of South Carolina, Charleston.
In a cost-utility model examining the potential impact of EPT in 11 states where it was illegal in 2007 (one state, North Dakota, has since made the practice legal), she estimated there would be a cost savings of almost $6 million and the prevention of more than 2,000 cases of Chlamydia trachomatis and Neisseria gonorrhoeae annually.
Using estimates of disease prevalence, treatment failure, costs, and quality-adjusted life years, EPT would have resulted in 984 fewer cases of chlamydia (rather than the actual 196,819 cases) and 1,280 fewer cases of gonorrhea (rather than the actual 56,585 cases). This reduction in disease would have resulted in a net savings of $1,671,387 for chlamydia and $4,163,534 for gonorrhea, and a combined gain of 453 quality-adjusted life years.
Currently, in the 19 U.S. states where EPT is explicitly legal, “there are state statutes that either allow for the provision of a prescription in general or specifically for the treatment of STDs only,” she said. But there are 21 states where the laws are “somewhat murky. Either there are no laws, which means that presumably you can go ahead and provide this treatment” or there's nothing prohibiting treatment. She said that approximately 1 year ago the American Bar Association sent an open letter to all members encouraging states and localities to pass statutes that might decrease barriers to the implementation of EPT.
“Improved clarification of the legal status of EPT, whether it is a state law which only allows the prescription of medications for STDS or whether it is a broader general law, might actually make this type of treatment more acceptable to physicians,” she said in an interview.
However, she said that both legal and clinical concerns are barriers to EPT. “Research studies have shown that there are few risks to partners who receive EPT and there are significant benefits. I think if the legal status of EPT was clarified, it would be much easier to educate physicians about its benefits,” she said, noting that the logical places to prescribe EPT are health departments, which are usually state administered.
Dr. Villers noted that her study probably underestimates the benefits of EPT because it is based on the assumption that the infected patient was female, and was confined to the 3-month period following her treatment. Also we did not take into account multiple sexual partners, and we only looked at direct medical costs, not indirect costs, such as time off from work.