An economic evaluation of screening for Chlamydia trachomatis in adolescent males
M. Genc, L. Ruusuvaara and P. A. Mardh
Uppsala University Centre for STD Research, Sweden.
OBJECTIVE--To assess the cost-effectiveness of identifying asymptomatic
carriers of Chlamydia trachomatis among adolescent males.
DESIGN--Cost-effectiveness analysis based on cohort analytic studies
previously reported and average salaries and costs of medical care in
Sweden. SETTING--Adolescent males attending a primary care center for
routine health checks. PARTICIPANTS--Estimates of costs and benefits are
based on a cohort of 1000 adolescent males and their female contacts.
INTERVENTION--Screening with enzyme immunoassay (EIA), either on leukocyte
esterase (LE)--positive urine samples (LE-EIA screening) or on all urine
samples (EIA screening), was compared with no screening (no treatment or
contact tracing). The effects of confirming positive EIA results with a
blocking assay and alternative antibiotic regimens on the outcome of the
screening strategies were also evaluated. RESULTS--Compared with no
screening, the LE-EIA and EIA screening strategies reduced the overall
costs when the prevalence of chlamydial infection in males exceeded 2% and
10%, respectively. Enzyme immunoassay screening achieved an overall cure
rate that was 12.2% to 12.6% (95% confidence interval) better, but reduced
the incremental savings by at least $2144 per cured male, in comparison
with LE-EIA screening. Confirmation of positive EIA results reduced the
overall cost of the LE-EIA screening strategy when the prevalence of C
trachomatis among males was less than 8%. Compared with a 7-day course of
doxycycline, a single oral dose of azithromycin administered under
supervision in the clinic improved the cure rates of both EIA and LE-EIA
screening strategies by 15.1% to 16.3% and 11.2% to 12.0%, respectively,
while reducing the corresponding overall costs by 5% and 9%, respectively,
regardless of the prevalence of chlamydial infection in males.
CONCLUSION--The use of LE-EIA screening combined with treatment of positive
cases with azithromycin was the most cost-effective intervention strategy
focusing on asymptomatic male carriers of C trachomatis. Positive EIA
results should be confirmed when screening low-risk populations.
Screening for Chlamydia trachomatis: a systematic review of the economic evaluations and modelling.
Roberts et al.
Sex. Transm. Infect. 2006;82:193-200.
ABSTRACT
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A Swedish cost-effectiveness analysis of community-based Chlamydia trachomatis PCR testing of postal urine specimens obtained at home
Novak et al.
Scand J Public Health 2004;32:324-332.
ABSTRACT
Chlamydia trachomatis prevalence in men in the mid-west of Ireland
Powell et al.
Sex. Transm. Infect. 2004;80:349-353.
ABSTRACT
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What Is Known About the Cost-Effectiveness of Health Services for Returning Prisoners?
Howell et al.
JOURNAL OF CORRECTIONAL HEALTH CARE 2004;10:399-436.
ABSTRACT
Evaluating Adolescents in Juvenile Detention Facilities for Urogenital Chlamydial Infection: Costs and Effectiveness of Alternative Interventions
Mrus et al.
Arch Pediatr Adolesc Med 2003;157:696-702.
ABSTRACT
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What should we do about screening for genital chlamydia?
Low and Egger
Int J Epidemiol 2002;31:891-893.
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Cost effectiveness analysis of a population based screening programme for asymptomatic Chlamydia trachomatis infections in women by means of home obtained urine specimens
van Valkengoed et al.
Sex. Transm. Infect. 2001;77:276-282.
ABSTRACT
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Subsequent Sexually Transmitted Infection in Urban Adolescents and Young Adults
Orr et al.
Arch Pediatr Adolesc Med 2001;155:947-953.
ABSTRACT
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Comparative Model-based Analysis of Screening Programs for Chlamydia trachomatis Infections
Kretzschmar et al.
Am J Epidemiol 2001;153:90-101.
ABSTRACT
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Expanding Efforts to Prevent Chlamydial Infection
Stamm
NEJM 1998;339:768-770.
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Screening Adolescents for Sexually Transmitted Infections
Orr and Fortenberry
JAMA 1998;280:564-565.
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SCREENING AND TREATING ASYMPTOMATIC CHLAMYDIA
JWatch General 1993;1993:4-4.
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