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Relative Cost-Effectiveness of Different Tests for Chlamydia trachomatis
- Sue J. Goldie, MD, MPH;
- Delphine Hu, MD, MPH; and
- Edward W. Hook III, MD
- From Harvard School of Public Health, Boston, MA 02115, and University of Alabama at Birmingham, Birmingham, AL 35294.
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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.
Sue J. Goldie, MD, MPH
Delphine Hu, MD, MPH
Harvard School of Public Health; Boston, MA 02115
Edward W. Hook III, MD
University of Alabama at Birmingham; Birmingham, AL 35294
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article and Author Information
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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.
