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REPLY
Relative Cost-Effectiveness of Different Tests for Chlamydia trachomatis
Sue J. Goldie, MD, MPH;
Delphine Hu, MD, MPH; and
Edward W. Hook, III, MD
15 February 2005 | Volume 142 Issue 4 | Pages 308-309
IN RESPONSE:
We appreciate Dr. Jackson's interest and comment. We believe that our model has the potential to help inform many questions relating to chlamydia screening and chose to start by exploring the impact of different approaches to routine screening for young women from a long-term, societal perspective. Our analysis was intended to inform broad recommendations for national screening guidelines, with particular emphasis on optimal target age range and frequency. At the same time, a wide variety of diagnostic tests are available for C. trachomatis detection, including cell culture, antigen-detection tests, nucleic acid hybridization tests, and, most recently, nucleic acid amplification tests. Compared with nonamplified tests, nucleic acid amplification tests have been demonstrated to have superior sensitivity and greater acceptability among adolescents and young adults (1-3), although at a higher cost. As pointed out in Stamm's commentary (4), many public health–based screening programs have limited resources and consequently are able to offer screening to less than half of the target population. This fact illustrates an important distinction between the cost-effectiveness (that is, "value for money") of an available technology from a societal perspective and the affordability of that technology from the perspective of one particular payer (for example, a public health clinic). An analysis that comparatively evaluates a wide array of available screening tests and considers a shorter time horizon, while explicitly taking into account the available budget, would be useful for regional and local decision making. Such analyses are complex: To accurately reflect the tradeoffs associated with different tests, data on the likelihood of adherence to different tests and the correlation between adherence and preferences would be required. We agree that this type of analysis is of high priority.
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Author and Article Information
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From Harvard School of Public Health, Boston, MA 02115, and University of Alabama at Birmingham, Birmingham, AL 35294.
Potential Financial Conflicts of Interest: Dr. Hook has received research support from Abbott Laboratories; Roche Molecular Systems, Inc.; Gen-Probe; and Becton, Dickinson, & Co. and honoraria from Abbott Laboratories and Gen-Probe.
1. Watson EJ, Templeton A, Russell I, Paavonen J, Mardh PA, Stary A, et al. The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. J Med Microbiol. 2002;51:1021-31. [PMID: 12466399].
2. Nsuami M, Cohen DA. Participation in a school-based sexually transmitted disease screening program. Sex Transm Dis. 2000;27:473-9. [PMID: 10987455].
3. Wiesenfeld HC, Lowry DL, Heine RP, Krohn MA, Bittner H, Kellinger K, et al. Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents. Sex Transm Dis. 2001;28:321-5. [PMID: 11403188].
4. Stamm WE. Chlamydia screening: expanding the scope [Editorial]. Ann Intern Med. 2004;141:570-2. [PMID: 15466776].
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Screening for Chlamydia trachomatis in Women 15 to 29 Years of Age: A Cost-Effectiveness Analysis
Delphine Hu, Edward W. Hook, III, AND Sue J. Goldie
- Annals 2004 141: 501-513.
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