The impact of natural history parameters on the cost-effectiveness of Chlamydia trachomatis screening strategies.
OBJECTIVE
To understand the potential impact of assumptions about the natural history of untreated Chlamydia trachomatis on the cost-effectiveness of screening strategies.


METHODS
Using a previously developed state-transition model, we explored how alternative assumptions about the natural history of disease following infection affect the estimated cost-effectiveness of screening for U.S. women. The analysis was conducted from a modified societal perspective and incorporated a lifetime analytic horizon.


RESULTS
Different natural history assumptions affect cost-effectiveness outcomes. Assumptions about the combined risk of persistent and repeat infections have the greatest impact on the composition of optimal screening strategies, whereas assumptions about the risk of pelvic inflammatory disease most greatly influenced the magnitude of incremental cost-effectiveness ratios.


CONCLUSIONS
Priorities for future C trachomatis research should include better estimates of the risk of pelvic inflammatory disease, persistence, and repeat infection. Better delineation of these variables will permit improved evaluation of potential screening activities.
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02138, USA. dhu@camail.harvard.edu
Delphine
D
Hu
Edward W
EW
Hook
Sue J
SJ
Goldie
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D002692:Chlamydia trachomatis; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008962:Models, Theoretical; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States / Q000453:epidemiology