title: Estimation of the burden of disease and costs of genital Chlamydia trachomatis infection in Canada.
abstract: BACKGROUND
  Rates of Chlamydia trachomatis (CT) infection in Canada have been increasing since the mid-1990s. We sought to estimate the burden of CT in this population.
  
  
  METHODS
  We developed an age- and sex-structured mathematical model parameterized to reproduce trends in CT prevalence between 1991 and 2009 in the Canadian population aged 10 to 39 years. Costs were identified, measured, and valued using a modified societal perspective and converted to year 2009 Canadian dollars. Cost-effectiveness of the implemented policy of enhanced screening for asymptomatic infections was estimated by comparison with model-projected trends in the absence of increased screening. Main outcome measures were current net cost and burden of illness attributable to CT infection, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Under base case model assumptions, there was a trend of increasing detection of CT cases (due to increases in screening), despite an underlying stabilization of actual CT infections. Average estimated costs associated with CT infection over this period were $51.4 million per year. Costs of screening and treatment of asymptomatic infections as a proportion of total CT costs were estimated to have increased over time, whereas costs of long-term sequelae associated with untreated infections declined over the same period. Compared with no change in screening, enhanced screening was estimated to be highly cost-effective, with an incremental cost-effectiveness ratio of $2910 per quality-adjusted life year.
  
  
  CONCLUSIONS
  Despite increases in screening, the economic burden of CT in Canada remains high. Further investigation of trends in chlamydia-associated complications is required to better understand the impact of screening on incidence.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ashleigh R
authors.initials: AR
authors.lastname: Tuite
authors.forename: Gayatri C
authors.initials: GC
authors.lastname: Jayaraman
authors.forename: Vanessa G
authors.initials: VG
authors.lastname: Allen
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002648:Child; D002690:Chlamydia Infections / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000472:pathogenicity*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008962:Models, Theoretical; D012680:Sensitivity and Specificity; D055815:Young Adult