The clinical and economic consequences of screening young men for genital chlamydial infection.
BACKGROUND
Wide-scale application of urine-based screening of asymptomatic men for chlamydial infection has not been thoroughly assessed.


OBJECTIVE
The goal was to compare clinical and economic consequences of three strategies: (1). no screening, (2). screening with ligase chain reaction (LCR) assay of urine, and (3). prescreening urine with a leukocyte esterase test (LE) and confirming positives with LCR.


METHODS
We used a decision analytic model.


RESULTS
At a chlamydia prevalence of 5%, the no screening cost was US dollars 7.44 per man screened, resulting in 522 cases of pelvic inflammatory disease (PID) per 100000 men. LE-LCR was most cost-effective, preventing 242 cases of PID over no screening at an additional cost of US dollars 29.14 per male screened. The LCR strategy prevented 104 more cases of PID than LE-LCR but cost US dollars 22.62 more per male screened. For this to be more efficient than LE-LCR, the LCR assay cost needed to decline to <or=US dollars 18.


CONCLUSIONS
At a chlamydia prevalence of 5%, LE-LCR is the most efficient use of resources. If LCR cost decreases or chlamydia prevalence increases, the LCR strategy is favored.
Ginocchio
Rachel H S
RH
Department of Health Services, Maternal and Child Health, University of Washington, Seattle, Washington 98104, USA.
Veenstra
David L
DL
Connell
Frederick A
FA
Marrazzo
Jeanne M
JM
D001431:Bacteriological Techniques; D002265:Carboxylic Ester Hydrolases / Q000652:urine*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D005832:Genital Diseases, Male / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D022521:Ligase Chain Reaction / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000191:economics; D000292:Pelvic Inflammatory Disease / Q000517:prevention & control; D015995:Prevalence; D012680:Sensitivity and Specificity; D014556:Urine / Q000382:microbiology
C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases