Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal.
OBJECTIVE
We used decision analysis to calculate the economic implications of routine testing for Neisseria gonorrhoeae infection of the cervix. This study compared performing endocervical cultures in all women seeking routine gynecologic care to a no-test strategy. Estimates derived from the medical literature were varied in a sensitivity analysis, and a Monte Carlo technique was used to incorporate the estimates of experts into the analysis.


RESULTS
We found that routinely testing for gonorrhea reduced overall medical costs when the prevalence of infection exceeded 1.5 percent. This result was most sensitive to variation in the cost of the culture and the assumption that treatment prevents adverse sequelae. Reducing the estimated cost of the culture from $9 to $5 decreased the threshold prevalence from 1.5 to 0.8 percent. When we considered the variation in estimates of experts, the threshold prevalence increased from 1.5 to 2.1 percent.


CONCLUSIONS
We conclude that a strategy of testing and treating selected women with risk factors for gonorrhea will not only reduce the likelihood of the development of serious adverse sequelae but will also result in a reduction of medical costs.
Phillips
R S
RS
Division of General Medicine and Primary Care, Beth Israel Hospital, Boston, Massachusetts 02215.
Safran
C
C
Aronson
M D
MD
Taylor
W C
WC
D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006069:Gonorrhea / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D012307:Risk Factors; D012488:Salpingitis / Q000191:economics / Q000453:epidemiology; D002575:Uterine Cervicitis / Q000191:economics* / Q000453:epidemiology