title: Cost-effectiveness of screening strategies for Chlamydia trachomatis using cervical swabs, urine, and self-obtained vaginal swabs in a sexually transmitted disease clinic setting.
abstract: BACKGROUND
  We evaluated the cost-effectiveness of Chlamydia screening strategies that use different methods of specimen collection: cervical swabs, urines, and self-obtained vaginal swabs.
  
  
  METHODS
  A decision analysis was modeled for a hypothetical cohort of 10,000 per year of women attending sexually transmitted disease (STD) clinics. Incremental cost-effectiveness of 4 screening strategies were compared: 1) Endocervical DNA probe test (PACE2, Gen-Probe), 2) Endocervical AC2 (Aptima Combo 2, Gen-Probe), 3) Self-Obtained Vaginal AC2, and 4) Urine AC2. Sensitivities of the vaginal, urine, and cervical AC2 tests were derived from 324 women attending STD clinics. The primary outcome was cases of pelvic inflammatory disease prevented. The model incorporated programmatic screening and treatment costs and medical cost savings from sequelae prevented.
  
  
  RESULTS
  Chlamydia prevalence in the sampled population was 11.1%. Sensitivities of vaginal, urine, and cervical AC2 were 97.2%, 91.7%, and 91.7%, respectively. The sensitivity of the DNA probe was derived from the literature and estimated at 68.8%. The self-obtained vaginal AC2 strategy was the least expensive and the most cost-effective, preventing 17 more cases of pelvic inflammatory disease than the next least expensive strategy.
  
  
  CONCLUSIONS
  Use of a vaginal swab to detect Chlamydia in this STD clinic population was cost-saving and cost-effective.
authors.affiliation: Department of Pediatrics, Division of Adolescent Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. diane.blake@umassmed.edu
authors.forename: Diane R
authors.initials: DR
authors.lastname: Blake
authors.forename: Nancy
authors.initials: N
authors.lastname: Maldeis
authors.forename: Mathilda R
authors.initials: MR
authors.lastname: Barnes
authors.forename: Andrew
authors.initials: A
authors.lastname: Hardick
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D008396:Maryland / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics*; D000292:Pelvic Inflammatory Disease / Q000382:microbiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D015995:Prevalence; D012646:Self Administration; D012680:Sensitivity and Specificity; D016482:Urinalysis / Q000191:economics / Q000379:methods; D014626:Vaginal Smears / Q000191:economics / Q000379:methods
chemical_list: D004269:DNA, Bacterial