Cost-effectiveness of Chlamydia antibody tests in subfertile women.
BACKGROUND
For the evaluation of tubal function, Chlamydia antibody testing (CAT) has been introduced as a screening test. We compared six CAT screening strategies (five CAT tests and one combination of tests), with respect to their cost-effectiveness, by using IVF pregnancy rate as outcome measure.


METHODS
A decision analytic model was developed based on a source population of 1715 subfertile women. The model incorporates hysterosalpingography (HSG), laparoscopy and IVF. To calculate IVF pregnancy rates, costs, effects, cost-effectiveness and incremental costs per effect of the six different CAT screening strategies were determined.


RESULTS
pELISA Medac turned out to be the most cost-effective CAT screening strategy (15 075 per IVF pregnancy), followed by MIF Anilabsystems (15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; 15 127) did not improve the cost-effectiveness of the single strategies. Sensitivity analyses showed that the results are robust for changes in the baseline values of the model parameters.


CONCLUSIONS
Only small differences were found between the screening strategies regarding the cost-effectiveness, although pELISA Medac was the most cost-effective strategy. Before introducing a particular CAT test into clinical practice, one should consider the effects and consequences of the entire screening strategy, instead of only the diagnostic accuracy of the test used.
Fiddelers
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Department of Clinical Epidemiology and Medical Technology Assessment, Academisch Ziekenhuis Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Afi@kemta.azm.nl
Land
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JA
Voss
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Kessels
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AG
Severens
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JL
D000907:Antibodies, Bacterial / Q000097:blood; D002689:Chlamydia / Q000276:immunology / Q000302:isolation & purification*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000191:economics / Q000382:microbiology*; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D017059:Models, Econometric; D011247:Pregnancy; D012680:Sensitivity and Specificity
D000907:Antibodies, Bacterial