title: The program cost and cost-effectiveness of screening men for Chlamydia to prevent pelvic inflammatory disease in women.
abstract: BACKGROUND
  Because men transmit Chlamydia trachomatis to women, screening men to prevent pelvic inflammatory disease in women may be a viable strategy. However, the cost-effectiveness of this approach requires careful assessment.
  
  
  METHODS
  Data from a demonstration project and longitudinal study that examined screening men for chlamydia were applied to a compartment-based transmission model to estimate the cost-effectiveness of screening men for chlamydia compared with alternative interventions, including expanded screening of women and combining disease investigation specialist-provided partner notification with screening. Cases of pelvic inflammatory disease and quality-adjusted life years lost were the primary outcome measures. A male screening program that screened 1% of men in the population annually was modeled.
  
  
  RESULTS
  A program targeting high-risk men for screening (those with a larger number of partners in the previous year than the general population and a higher chlamydia prevalence) was cost saving compared with using equivalent program dollars to expand screening of lower-risk women. Combining partner notification with male screening was more effective than screening men alone. In sensitivity analyses, the male program was not always cost saving but averaged $10,520 per quality-adjusted life year saved over expanded screening of women.
  
  
  CONCLUSIONS
  Screening men can be a cost-effective alternative to screening women, but the men screened must have a relatively high prevalence compared with the women to whom screening would be expanded (under baseline assumptions, the prevalence in screened men was 86% higher than that of screened women). These modeling results suggest that programs targeting venues that have access to high-risk men can be effective tools in chlamydia prevention.
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. tgift@cdc.gov
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gift
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: Charlotte K
authors.initials: CK
authors.lastname: Kent
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Marrazzo
authors.forename: Cornelis A
authors.initials: CA
authors.lastname: Rietmeijer
authors.forename: Julia A
authors.initials: JA
authors.lastname: Schillinger
authors.forename: Eileen F
authors.initials: EF
authors.lastname: Dunne
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000191:economics / Q000382:microbiology / Q000635:transmission; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D016358:Contact Tracing / Q000191:economics; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015995:Prevalence; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D012747:Sexual Partners; D014481:United States; D014504:Urban Health; D055815:Young Adult