Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis.
BACKGROUND
Clinical guidelines have traditionally advised annual Chlamydia trachomatis screening for women younger than 25 years of age.


OBJECTIVE
To assess the cost-effectiveness of recently proposed strategies for chlamydia screening.


METHODS
State transition simulation model; cost-effectiveness analysis.


METHODS
Published literature.


METHODS
Sexually active U.S. women 15 to 29 years of age.


METHODS
Lifetime.


CONCLUSIONS
Modified societal.


METHODS
Four strategies targeted to 3 specific age groups (15 to 19 years, 15 to 24 years, and 15 to 29 years): 1) no screening, 2) annual screening for all women, 3) annual screening followed by 1 repeated test within 3 to 6 months after a positive test result, and 4) annual screening followed by selective semiannual screening for women with a history of infection.


METHODS
Clinical events (for example, pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and infertility), lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios.


RESULTS
Annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection was the most effective and cost-effective strategy. It consistently had an incremental cost-effectiveness ratio less than 25,000 dollars per quality-adjusted life-year (QALY) compared with the next most effective strategy. When the indirect transmission effects of a 10-year screening program on the probability of infection in uninfected women (that is, per-susceptible rate of infection) were considered, all strategies became more cost-effective.


RESULTS
Results were sensitive to the annual incidence of chlamydia, probability of persistent infection, screening test costs, and costs of treating long-term complications. Each variable was associated with threshold values beyond which screening became cost-saving. In probabilistic analysis, annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection had an incremental cost-effectiveness ratio less than 50,000 dollars per QALY in 99% of simulations.


CONCLUSIONS
Uncertainty about the natural history of chlamydial infection and consideration of only the indirect transmission effects of C. trachomatis screening.


CONCLUSIONS
Annual C. trachomatis screening for all women 15 to 29 years of age and selective targeting of those with a history of infection for semiannual screening is very cost-effective compared with other well-accepted clinical interventions.
Harvard School of Public Health, Boston, Massachusetts 02115-5924, USA.
Delphine
D
Hu
Edward W
EW
Hook
Sue J
SJ
Goldie
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D002692:Chlamydia trachomatis; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity