An economic evaluation of screening for Chlamydia trachomatis in adolescent males.
OBJECTIVE
To assess the cost-effectiveness of identifying asymptomatic carriers of Chlamydia trachomatis among adolescent males.


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


METHODS
Adolescent males attending a primary care center for routine health checks.


METHODS
Estimates of costs and benefits are based on a cohort of 1000 adolescent males and their female contacts.


METHODS
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.


CONCLUSIONS
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.
Genç
M
M
Uppsala University Centre for STD Research, Sweden.
Ruusuvaara
L
L
Mårdh
P A
PA
D000293:Adolescent; D017963:Azithromycin / Q000627:therapeutic use; D002265:Carboxylic Ester Hydrolases / Q000652:urine; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control* / Q000652:urine; D002692:Chlamydia trachomatis; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D007124:Immunoenzyme Techniques / Q000191:economics; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D013548:Sweden
D017963:Azithromycin; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases; D004318:Doxycycline