Is the routine pelvic examination needed with the advent of urine-based screening for sexually transmitted diseases?
OBJECTIVE
To determine the most cost-effective method of screening for chlamydia and gonorrhea to prevent pelvic inflammatory disease (PID) in asymptomatic sexually active adolescent females.


METHODS
Cost-effectiveness decision analysis comparing pelvic examination with cervical screening (the current national standard) with a model of urine screening with ligase chain reaction testing for Chlamydia trachomatis and Neisseria gonorrhoeae.


METHODS
Four strategies using decision analysis were compared for a potential cohort of 100000 asymptomatic sexually active young women: (1) pelvic examination screening in 100%; (2) urine screening in 100%; (3) actual predicted pelvic examination screening in 70%; and (4) actual predicted urine screening in 90%. Assumptions and costs were generated from published sources.


METHODS
Cases of PID prevented per year and cost to prevent a case of PID.


RESULTS
A total of 1750 cases of PID would be predicted to occur per year with no screening. Strategy 1 would prevent the most cases of PID (1283) at a mean cost of $10230. Strategy 2 would prevent 1215 cases of PID at a mean cost of $5093. The marginal cost to prevent an additional case of PID by strategy 1 is $101454. Strategy 3 would prevent 898 cases of PID and 1093 cases of PID would be prevented with urine screening in strategy 4.


CONCLUSIONS
Urine-based ligase chain reaction screening is the most cost-effective strategy to detect chlamydial and gonococcal genital infection in asymptomatic sexually active adolescent females and, owing to ease of implementation, the most likely to prevent the greatest number of cases of PID.
Shafer
M A
MA
Department of Pediatrics, University of California, San Francisco 94143-0503, USA. shafer@itsa.ucsf.edu
Pantell
R H
RH
Schachter
J
J
D000293:Adolescent; D002648:Child; D002690:Chlamydia Infections / Q000175:diagnosis / Q000191:economics; D002692:Chlamydia trachomatis; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000191:economics; D006801:Humans; D008297:Male; D000292:Pelvic Inflammatory Disease / Q000191:economics / Q000517:prevention & control; D010808:Physical Examination / Q000191:economics; D016133:Polymerase Chain Reaction / Q000191:economics; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000191:economics; D014556:Urine / Q000382:microbiology*; D014626:Vaginal Smears / Q000191:economics