Cost-effectiveness of partner pharmacotherapy in screening women for asymptomatic infection with Chlamydia Trachomatis.
OBJECTIVE
To assess the cost-effectiveness of pharmacotherapy for male partners in screening women for asymptomatic infection with Chlamydia trachomatis (CT).


METHODS
A pharmacoeconomic decision analysis model was constructed for the health outcomes of a CT screening program, such as averted cases of pelvic inflammatory disease and infertility (major outcomes). Reinfection in the absence of partner pharmacotherapy was included in the model. Cost-effectiveness from a societal perspective was estimated for prevalence data from a selective opportunistic screening program in Amsterdam. For diagnosis of asymptomatic CT infection a Ligase Chain Reaction (LCR) test on urine was used; for pharmacotherapy of women and partners azithromycin was used. By linking health outcomes with health care costs and productivity losses, averted costs were estimated. Cost-effectiveness was expressed as net costs per major outcome averted.


RESULTS
Partner pharmacotherapy reduces net costs per major outcome averted of the screening program by approximately 50%. Sensitivity analysis indicates significant improvements in cost-effectiveness of the screening program, even when relevant assumptions are varied. Within the broader framework of the screening program, partner pharmacotherapy is a cost-saving activity.


CONCLUSIONS
Inclusion of partner pharmacotherpy provides significant improvements in overall cost-effectiveness of the CT screening program among women aged 15 to 29. Partner pharmacotherapy lowers net costs per major outcome averted to the realm where implementation of the screening program should be considered. Considering the cost-saving potential, male partner pharmacotherapy should be pursued within the broader framework of a CT screening program for women. Reinfection should be included in any future pharmacoeconomic model of CT screening. Further work on this type of model should also be directed to linking cost-effectiveness to epidemiological models for the long-term spread of infectious diseases in populations.
Postma
M J
MJ
Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. m.postma@farm.rug.nl
Welte
R
R
van den Hoek
J A
JA
van Doornum
G J
GJ
Jager
H C
HC
Coutinho
R A
RA
D000293:Adolescent; D000328:Adult; D017963:Azithromycin / Q000191:economics / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D017850:Economics, Pharmaceutical; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D022521:Ligase Chain Reaction / Q000191:economics; D008297:Male; D008403:Mass Screening / Q000191:economics*; D009426:Netherlands; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000191:economics; D012747:Sexual Partners
D017963:Azithromycin