Screening for Chlamydia trachomatis in adolescent males: a cost-based decision analysis.
To evaluate the cost and benefits of screening tests for Chlamydia trachomatis in adolescent males, we developed a decision analysis model and compared the leukocyte esterase urine dipstick test with culture, with direct-smear fluorescent antibody (DFA), and with the option of no screening (no treatment). The leukocyte esterase test has the lowest average cost-per-cure ($51) compared with direct-smear fluorescent antibody ($192) and culture ($414). Compared with the DFA, we estimate that the leukocyte esterase test saves over $9,727 per cohort of 1,000 sexually active adolescent males screened. Sensitivity analyses show the leukocyte esterase test results in a lower cost-per-cure and lower overall costs (per cohort) than culture and direct-smear fluorescent antibody at any prevalence of C. trachomatis infection, and lower overall costs (per cohort) than no screening at prevalences above 21 percent.
Randolph
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Medical Scholars Program, Stanford University School of Medicine, San Francisco, CA.
Washington
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D000293:Adolescent; D002690:Chlamydia Infections / Q000191:economics / Q000517:prevention & control*; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D015169:Colony Count, Microbial / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004950:Esterases / Q000652:urine; D005260:Female; D005455:Fluorescent Antibody Technique / Q000191:economics; D006801:Humans; D007962:Leukocytes / Q000201:enzymology; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic / Q000191:economics; D014481:United States
D011933:Reagent Kits, Diagnostic; D004950:Esterases