Control of Chlamydia trachomatis infections in female army recruits: cost-effective screening and treatment in training cohorts to prevent pelvic inflammatory disease.
BACKGROUND
Chlamydia trachomatis genitourinary infections in females can lead to serious and costly sequelae. Programs such as basic (initial entry) military training with controlled points of entry offer an opportunity to screen large cohorts of women at risk for infection.


OBJECTIVE
To assess the cost-effectiveness of three interventions for C. trachomatis infections in women beginning Army training: 1) screening using urine ligase chain reaction (LCR) by age, 2) unrestricted testing using urine LCR, and 3) universal antibiotic treatment with azithromycin.


METHODS
Cost-effectiveness analysis from a military perspective.


METHODS
A hypothetical cohort of 10,000 women who intended to complete at least 2 years of military service was studied. Analysis was based on data from 13,204 female trainees screened for chlamydial infection at Fort Jackson, SC.


RESULTS
Program and training costs, cost of illness averted, and pelvic inflammatory disease (PID) prevented were determined for a 1-year follow-up period. Using sensitivity analysis, outcomes over 2 years were studied.


RESULTS
At a 9.2% prevalence, no screening resulted in $220,900 in training and sequelae costs and 276 cases of PID. Screening by age produced the lowest cost $217,600, over a 1-year period and prevented 222 cases of PID for a cost-savings of $15 per case of PID prevented. Universal testing prevented an additional 11 cases of PID at a cost of $226,400, or costing $800 per additional case of PID prevented over age-targeted screening. Universal treatment prevented an additional 32 cases of PID and cost $221,100, saving $167 per additional cases of PID prevented over universal screening. Over a 2-year period, universal treatment provided the highest cost-savings and prevented the most disease.


CONCLUSIONS
Screening by age provided a cost-savings to the Army over a 1-year period. Other organizations accessing large cohorts of young women could also benefit, even in the short term, from implementation of an age-based chlamydial screening program. Universal testing or universal treatment may be warranted in which long-term societal goals, such as maximum reduction of PID, are relevant.
Howell
M R
MR
Division of Infectious Diseases, The Johns Hopkins University, Baltimore, Maryland 21205, USA.
Gaydos
J C
JC
McKee
K T
KT
Quinn
T C
TC
Gaydos
C A
CA
D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D011088:DNA Ligases; D005260:Female; D005784:Gene Amplification; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008889:Military Personnel; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014556:Urine / Q000382:microbiology
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D011088:DNA Ligases