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A Cost-effectiveness Analysis of Screening and Treatment for Chlamydia trachomatis Infection in Asymptomatic Women

Mehmet Genc, MD, PhD; and Per-Anders Mardh, MD, PhD
[+] Article and Author Information

From the Uppsala University Centre for STD Research, Uppsala, Sweden. Requests for Reprints: Mehmet Genc, MD, Institute of Clinical Bacteriology, Uppsala University Centre for STD Research, Box 552, S-75 122 Uppsala, Sweden. Current Author Addresses: Drs. Genc and Mardh: Institute of Clinical Bacteriology, Uppsala University Centre for STD Research, Box 552, S-75 122 Uppsala, Sweden.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;124(1_Part_1):1-7. doi:10.7326/0003-4819-124-1_Part_1-199601010-00001
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Objective: To assess the cost-effectiveness of identifying and treating asymptomatic female carriers of Chlamydia trachomatis.

Design: Cost-effectiveness analysis based on previously reported cohort analytic studies and average salaries and costs of medical care in Sweden.

Setting: Women attending youth, family planning, and gynecology clinics.

Participants: 1000 women and their male sex partners.

Intervention: Screening with tissue cell culture, confirmed enzyme immunoassay, and DNA amplification assays based on either polymerase chain reaction or ligase chain reaction was compared with no screening (no treatment and no tracing of sexual contacts). The effect of antibiotic regimens on the outcome of the screening strategies was also evaluated.

Results: When the prevalence of chlamydial infection exceeded 6%, screening of women with DNA amplification assay and treatment of positive patients with a single oral dose of azithromycin given under supervision in the clinic was the most cost-effective intervention strategy. At greater prevalences, screening with enzyme immunoassay also generated savings and improved the cure rates compared with no screening, but such screening was less cost-effective than screening with a DNA amplification assay. Compared with no intervention, tissue cell culture is cost-effective only when the prevalence of infection is greater than 14%. Compared with the azithromycin regimen, the standard 7-day, twice-daily doxycycline regimen resulted in significantly lower cure rates because of patients' poor compliance with this regimen.

Conclusion: For asymptomatic female carriers of C. trachomatis, screening with a DNA amplification assay combined with the single-dose azithromycin treatment of positive patients is the most cost-effective strategy when the prevalence is 6%. When the prevalence is lower than 6%, the decision to choose a competing strategy depends on the physician's view of the value of preventing an illness caused by untreated chlamydial infection.

Figures

Grahic Jump Location
Figure 1.
Decision tree showing the outcomes of screening strategies for Chlamydia trachomatis among women and the outcomes of no screening.

The rectangle indicates the decision nodes; circles, chance nodes; filled circles, end of a branch; and the arrow, untreated chlamydial infection.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Decision tree showing the outcomes of tracing and treating contacts of women with a diagnosis of chlamydial infection of the genital tract and the outcomes of no contact tracing.Figure 1

The probabilities of chance node 8 were derived from the probabilities of the corresponding outcomes of screening men, indicated with letters a to f in . The rectangle indicates the decision nodes; circles, chance nodes; filled circles, end of a branch; and the arrow, untreated chlamydial infection.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Effect of prevalence on the incremental cost per cured woman when switching from no screening to screening with tissue cell culture, enzyme immunoassay, or DNA amplification assays for Chlamydia trachomatis among a cohort of 1000 women.

Persons with positive test results received either a 7-day, twice-daily course of doxycycline (panel A) or a single oral dose of azithromycin (panel B). Incremental cost per cured woman equals (total costs of screening minus total costs of no screening)/(number of cured women as a result of screening minus number of women cured spontaneously).

Grahic Jump Location

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