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Cost-effectiveness of Screening Women at Moderate Risk for Genital Infections Caused by Chlamydia trachomatis
Mary D. Nettleman, MD;
Robert B. Jones, MD, PhD
JAMA. 1988;260(2):207-213.
Abstract
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We evaluated the cost-effectiveness of screening women at moderate (prevalence, 7.9%) risk for urogenital infections with Chlamydia trachomatis. The characteristics of culture and direct antigen tests were based on published values. Those of serology were based on a comparative study in 434 college women. Three serological tests were evaluated: microimmunofluorescence, an indirect fluorescent antibody assay, and an enzyme-linked immunoassay. Their sensitivities and specificities were 97% and 64% 87% and 64%, and 84% and 51%, respectively, compared with culture. Screening all patients with a direct antigen test costing less than $12 was more cost-effective than neither testing nor treating patients, although only 53% of patients with positive test results would actually be infected. The use of culture alone or as a confirmatory test was less cost-effective but had high positive predictive values. Seropositivity was not highly predictive of active infection. Chlamydial screening can be cost-effective in moderate-risk women.
(JAMA 1988;260:207-213)
Author Affiliations
From the Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City (Dr Nettleman), and the Departments of Medicine, Microbiology, and Immunology, Indiana University School of Medicine, Indianapolis (Dr Jones).
Footnotes
Reprint requests to University of Iowa Hospitals and Clinics, C 41 GH, Iowa City, IA 52242 (Dr Nettleman).
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