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ARTICLE

Screening for Chlamydia trachomatis in Women 15 to 29 Years of Age: A Cost-Effectiveness Analysis

Delphine Hu, MD, MPH; Edward W. Hook, III, MD; and Sue J. Goldie, MD, MPH

5 October 2004 | Volume 141 Issue 7 | Pages 501-513

Background: Clinical guidelines have traditionally advised annual Chlamydia trachomatis screening for women younger than 25 years of age.

Objective: To assess the cost-effectiveness of recently proposed strategies for chlamydia screening.

Design: State transition simulation model; cost-effectiveness analysis.

Data Sources: Published literature.

Target Population: Sexually active U.S. women 15 to 29 years of age.

Time Horizon: Lifetime.

Perspective: Modified societal.

Interventions: Four strategies targeted to 3 specific age groups (15 to 19 years, 15 to 24 years, and 15 to 29 years): 1) no screening, 2) annual screening for all women, 3) annual screening followed by 1 repeated test within 3 to 6 months after a positive test result, and 4) annual screening followed by selective semiannual screening for women with a history of infection.

Outcome Measures: Clinical events (for example, pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and infertility), lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios.

Results of Base-Case Analysis: Annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection was the most effective and cost-effective strategy. It consistently had an incremental cost-effectiveness ratio less than $25 000 per quality-adjusted life-year (QALY) compared with the next most effective strategy. When the indirect transmission effects of a 10-year screening program on the probability of infection in uninfected women (that is, per-susceptible rate of infection) were considered, all strategies became more cost-effective.

Results of Sensitivity Analysis: Results were sensitive to the annual incidence of chlamydia, probability of persistent infection, screening test costs, and costs of treating long-term complications. Each variable was associated with threshold values beyond which screening became cost-saving. In probabilistic analysis, annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection had an incremental cost-effectiveness ratio less than $50 000 per QALY in 99% of simulations.

Limitations: Uncertainty about the natural history of chlamydial infection and consideration of only the indirect transmission effects of C. trachomatis screening.

Conclusions: Annual C. trachomatis screening for all women 15 to 29 years of age and selective targeting of those with a history of infection for semiannual screening is very cost-effective compared with other well-accepted clinical interventions.

Editors' Notes Context Annual screening for Chlamydia trachomatis in sexually active women younger than 25 years of age is cost-effective, but the economic implications of more recent recommendations to expand screening to older women and to test more frequently in women with previous infection are unknown. Contribution The cost-effectiveness of annual screening in women 15 to 29 years of age followed by semiannual screening in those with previous infection is well within the range of other accepted health care interventions. In some scenarios, such as high-prevalence populations, screening was cost-saving. Implications Recently proposed screening recommendations for Chlamydia trachomatis are cost-effective. –The Editors

 

Author and Article Information

From Harvard School of Public Health, Boston, Massachusetts, and University of Alabama at Birmingham, Birmingham, Alabama.

Acknowledgments: The authors thank Karen Kuntz for guidance on probabilistic sensitivity analysis and Steven Sweet for technical advice and help with manuscript preparation.

Grant Support: By Agency for Healthcare Research and Policy Fellowship Award (Dr. Hu).

Potential Financial Conflicts of Interest:Consultancies: E.W. Hook (Abbott Laboratories, Gen-Probe); Honoraria: E.W. Hook (Abbott Laboratories, Gen-Probe); Other: E.W. Hook (Abbott Laboratories; Roche Molecular Systems, Inc.; Gen-Probe; Becton, Dickinson, and Co).

Requests for Single Reprints: Sue J. Goldie, MD, MPH, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115-5924.

Current Author Addresses: Drs. Hu and Goldie: Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115-5924.

Dr. Hook: Department of Medicine, University of Alabama at Birmingham, 703 19th Street South ZRB 242, Birmingham, AL 35294-0007.

Author Contributions: Conception and design: D. Hu, S.J. Goldie.

Analysis and interpretation of the data: D. Hu, E.W. Hook, S.J. Goldie.

Drafting of the article: D. Hu, S.J. Goldie.

Critical revision of the article for important intellectual content: D. Hu, E.W. Hook, S.J. Goldie.

Final approval of the article: D. Hu, E.W. Hook, S.J. Goldie.

Statistical expertise: S.J. Goldie.

Administrative, technical, or logistic support: S.J. Goldie.

Related articles in Annals:

Editorials
Chlamydia Screening: Expanding the Scope
Walter E. Stamm

Annals 2004 141: 570-572. [Full Text]  

Summaries for Patients
The Cost-Effectiveness of Screening for Chlamydia in Women 15 to 29 Years of Age

Annals 2004 141: I-29. [Full Text]  

Letters
Relative Cost-Effectiveness of Different Tests for Chlamydia trachomatis
Brian Jackson

Annals 2005 142: 308. [Full Text]  

Letters
Relative Cost-Effectiveness of Different Tests for Chlamydia trachomatis
Sue J. Goldie, Delphine Hu, AND Edward W. Hook, III

Annals 2005 142: 308-309. [Full Text]  

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