A cost-effectiveness evaluation of testing and treatment of Chlamydia trachomatis infection among asymptomatic women infected with Neisseria gonorrhoeae.
BACKGROUND
Because patients infected with Neisseria gonorrhoeae are frequently coinfected with Chlamydia trachomatis, routine dual treatment of patients with N gonorrhoeae infection is frequently practiced and has long been recommended.


OBJECTIVE
The goal of this study was to examine the cost-effectiveness of routine dual treatment of women with infection, with or without separate testing for C trachomatis, compared with an alternative of testing for both infections and restricting treatment for C trachomatis to women testing positive for C trachomatis.


METHODS
A decision analysis compared the cost-effectiveness of these options using cases of pelvic inflammatory disease prevented as the outcome. Parameter values were taken from the literature.


RESULTS
Routine dual treatment is not an effective or cost-effective replacement for testing for C trachomatis, but it can increase the number of cases of C trachomatis treated when combined with testing. Dual treatment results in more overtreatment of infection C trachomatis than treatment based on test results.


CONCLUSIONS
Testing for both infections is more cost-effective than routine presumptive treatment for C trachomatis. Providing both presumptive treatment and testing for C trachomatis can also be cost-effective in some settings.
Gift
Thomas
T
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Walsh
Cathleen
C
Haddix
Anne
A
Irwin
Kathleen L
KL
D000465:Algorithms; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006069:Gonorrhea / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000235:genetics / Q000302:isolation & purification; D009693:Nucleic Acid Hybridization / Q000379:methods; D000292:Pelvic Inflammatory Disease / Q000517:prevention & control