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15 February 1998 | Volume 128 Issue 4 | Pages 277-284
Background: Screening women for Chlamydia trachomatis in family planning clinics is associated with a reduced incidence of chlamydial sequelae. However, the question of whom to screen to maintain efficient use of resources remains controversial.
Objective: To assess the cost-effectiveness of chlamydial screening done according to three sets of criteria in asymptomatic women attending family planning clinics.
Design: Cost-effectiveness analysis done by using a decision model with the perspective of a health care system. Model estimates were based on analysis of cohort data, clinic costs, laboratory costs, and published data.
Setting: Two family planning clinics in Baltimore, Maryland.
Patients: 7699 asymptomatic women who presented between April 1994 and August 1996.
Intervention: Three screening strategies-screening according to the criteria of the Centers for Disease Control and Prevention (CDC), screening all women younger than 30 years of age, and universal screening-were retrospectively applied and compared. All women were tested with polymerase chain reaction.
Measurements: Medical outcomes included sequelae prevented in women, men, and infants. Total costs included screening program costs and future medical costs of all sequelae. The incremental cost-effectiveness ratios of each strategy were calculated.
Results: Without screening, 152 cases of pelvic inflammatory disease would occur at a cost of $676 000. Screening done by using the CDC criteria would prevent 64 cases of pelvic inflammatory disease at a cost savings of $231 000. Screening all women younger than 30 years of age would prevent an additional 21 cases of pelvic inflammatory disease and save $74 000. Universal screening would prevent an additional 6 cases of pelvic inflammatory disease but would cost $19 000 more than age-based screening, or approximately $3000 more per case of pelvic inflammatory disease prevented. If the prevalence of C. trachomatis is more than 10.2% or if less than 88.5% of infections occur in women younger than 30 years of age, universal screening provides the greatest cost savings.
Conclusions: These results suggest that age-based screening provides the greatest cost savings of the three strategies examined. However, universal screening is desirable in some situations. In general, screening done by using any criteria and a highly sensitive diagnostic assay should be part of any chlamydial prevention and control program or health plan.
Author and Article Information
From Johns Hopkins University, Baltimore, Maryland; and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
ARTICLE
Screening for Chlamydia trachomatis in Asymptomatic Women Attending Family Planning Clinics: A Cost-Effectiveness Analysis of Three Strategies
Acknowledgments: The authors thank Wayne Brathwaite, Nicole Novak, Samantha Johnston, and the family planning clinicians for their support.
Requests for Reprints: M. Rene Howell, MA, Johns Hopkins University, Division of Infectious Diseases, Ross Research Building, Room 1159, 720 Rutland Avenue, Baltimore, MD 21205.
Current Author Addresses: Ms. Howell and Drs. Quinn and Gaydos: Johns Hopkins University, Division of Infectious Diseases, Ross Research Building, Room 1159, 720 Rutland Avenue, Baltimore, MD 21205.
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