ABSTRACTS
Estimates of Cost-Effectiveness of Statewide Implementation of a Sexual Assault Post-Exposure Prophylaxis Protocol in the Emergency Medical ServicesAuthor: Ginny Renkiewicz, PhD, MHS, Paramedic, FAEMS | | Associate Authors: Erin Donathan, MPH, FP-C, Michael W. Hubble, PhD
Introduction Approximately 463,634 sexual assaults occur in the United States annually. Of these, 61% go unreported, 30% of victims contract a sexually transmitted infection (STI), and 5% result in pregnancy. In November 2022, Michigan implemented a sexual assault post-exposure prophylaxis (PEP) protocol for EMS. However, the cost-effectiveness of the protocol has not been determined. Objective To estimate the cost-effectiveness of implementing a statewide prehospital sexual assault PEP protocol in Michigan. Methods Using protocols provided by the Michigan Bureau of EMS, Trauma, and Preparedness and sexual assault data from the Michigan Department of Health and Human Services, a cost-effectiveness model for sexual assault PEP was computed. Model inputs included reported cases of sexual assault with or without vaginal penetration, rates of assault-related pregnancy, pregnancy disposition, initial and continuing training, medication stocking costs, and estimated STI cases. Projected reductions in outpatient treatment costs for medical abortion and STI treatment were based on previously reported estimates. Economic analyses were conducted from societal and state EMS system perspectives. Results In Michigan, 11,444 sexual assaults were encountered by EMS in 2022; 30% weren’t transported. Overall, 3,433 patients could be referred to community paramedics, 78.9% of which were of child-bearing age. Our estimates indicate that 1,142 patients could receive levonorgestrel, and 3,433 could receive STI prophylaxis. Overall, 57 abortions and 1,305 STIs could be avoided. The number needed to treat for unplanned pregnancy and STIs was 57 and 3, respectively. Year 1 PEP costs for EMS were $600,453, which included initial medication stocking, restocking, and training. Costs for years 2 and 3 included medication restocking only and were estimated at $14,629. Annual cost savings were estimated at $49,186 for avoided medical abortions and $291,134 for avoided STIs. From the societal perspective, the net monetary cost for avoided medical abortions and STIs was $260,133 in year 1, but a net monetary savings of $325,691 was projected in years 2 and 3. Conclusions Our model of financial implications and clinical benefits of implementing a statewide sexual assault PEP protocol suggests that such a program is a cost-effective strategy. Further research is needed to determine the true impact on the system and the influence on access to prophylactic care.
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