Table 1. Summary of key epidemiologic, economic, and demographic parameter estimation.

Study population	•    Average annual cohort of 27,700 Asian refugees based on Department of Homeland Security data for 2002–11, primarily from Southeast Asia and the Middle East. •    Assume 100% of refugees can be covered by presumptive treatment programs in the future, (currently, an estimated 85% of refugees travel from countries where presumptive treatment programs currently exist, the remaining 15% come from countries without presumptive treatment) •    90% of refugees present for comprehensive exams after arrival in the United States
Epidemiologic parameter estimation	•    Test sensitivities for infections vary from 78% for hookworm to 96% for Trichuris based on two stool ova and parasite tests and one Strongyloides serologic test. [24, 25] •    The estimated specificities were 100%, except for Strongyloides serology (92%). [24] •    Albendazole effectiveness was estimated based on a meta-analysis that reported efficacy varied between 28% against Trichuris to 88% against Ascaris infections. [26] •    Ivermectin efficacy was estimated to be 90% for a 2-day treatment regimen [27–29]. •    The prevalence of hookworm, Trichuris, and Ascaris infections (0.56% to 2.8%) was estimated from a multiyear study of newly-arrived refugees conducted in the State of Minnesota after adjustment for presumptive treatment and test sensitivity [5] using the following equation: True prevalence = ((Reported prevalence + Specificity—1) / (Sensitivity + Specificity– 1)) / (1 –effectiveness). •    The prevalence of Strongyoides infections (20%) was estimated using the median rate from a number of serologic studies conducted among relocated Asian refugees. [2, 3, 16, 17, 30] •    Duration of infection in the absence of treatment was: hookworm 6 years, Trichuris 2 years, Ascaris 1 year, Strongyloides indefinite [13] •    The annual probabilities of outpatient and inpatient cases given infection were estimated from two previous studies that estimated the incidence of inpatient and outpatient strongyloidiasis among immigrant populations in New York state and Barcelona, Spain. [14, 31] •    The risk of death from inpatient strongyloidiasis was estimated to be 16.7%. [15] •    We assumed that side effects of presumptive treatment would be minor and not of economic significance. [32]
Cost analysis	•    “Domestic Screening and Treatment” assumed two stool ova and parasite tests and one serologic test for Strongyloides infection comprising 10% of a comprehensive exam. Unit costs were estimated using two sets of reimbursement rates: 1) the Physician’s Fee and Coding Guide [23] and 2) the Medicare Physician Payment and Clinical Lab Fee Schedules [21, 22]. •    Persons with positive test results required a follow-up visit and albendazole for hookworm, Trichuris, or Ascaris infections or ivermectin for Strongyloides. •    Medicine costs were estimated from Red Book(R) data [18], assuming average dosages of 400 mg for albendazole and 18 mg for ivermectin. •    Outpatient treatment costs were based on an assumed battery of tests and two outpatient visits. •    Strongyloidiasis hospitalization costs were estimated from the 2006–2010 National Inpatient Sample data (ICD code 127.2) [33] and adjusted to 2013 USD using the Medical Consumer Price Index [34]. •    Opportunity costs were estimated based on screening time (2 hrs.), treatment given positive test (1 hr.), outpatient treatment (1 day), and hospitalization (10 days). •    The value of time was estimated using US GDP per capita-hr. estimates ($5.84 per hr.). [35] •    Cost estimates for Strongyloides-only screening for the “Overseas Albendazole and Domestic Screening for Strongyloides” program omitted stool ova and parasite testing costs and assumed that 5% of the comprehensive exam time would be required for serologic testing. •    Overseas presumptive treatment costs were estimated by IOM in 2013 and included medicine, delivery, administrative, and overhead cost data from three IOM sites.