title: Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States.
abstract: Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the United States (U.S.) [1] and remains a major public health problem. We determined the cost- benefit of screening all pregnant women aged 15-24 for Chlamydia trachomatis infection compared with no screening.
  
  
  
  We developed a decision analysis model to estimate costs and health-related effects of screening pregnant women for C. trachomatis in a high burden setting (Brooklyn, NY). Outcome data was from literature for pregnant women in the 2015 US population. A virtual cohort of 6,444,686 pregnant women, followed for 1 year was utilized. Using outcomes data from the literature, we predicted the number of C. trachomatis cases, associated morbidity, and related costs. Two comparison arms were developed: pregnant women who received chlamydia screening, and those who did not. Costs and morbidity of a pregnant woman-infant pair with C. trachomatis were calculated and compared.
  
  
  
  Cost and benefit of screening relied on the prevalence of C. trachomatis; when rates are above 16.9%, screening was proven to offer net cost savings. At a pre-screening era prevalence of 8%, a screening program has an increased expense of $124.65 million ($19.34/individual), with 328 thousand more cases of chlamydia treated, and significant reduction in morbidity. At a current estimate of prevalence, 6.7%, net expenditure for screening is $249.08 million ($38.65/individual), with 204.63 thousand cases of treated chlamydia and reduced morbidity.
  
  
  
  Considering a high prevalence region, prenatal screening for C. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs. Screening programs are appropriate if the cost per individual is deemed acceptable to prevent the morbidity associated with C. trachomatis.
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Ditkowsky
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
authors.forename: Khushal H
authors.initials: KH
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Hammerschlag
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kohlhoff
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA. tamar.smith-norowitz@downstate.edu.
authors.forename: Tamar A
authors.initials: TA
authors.lastname: Smith-Norowitz
mesh_terms: D000293:Adolescent; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D011295:Prenatal Care / Q000191:economics; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: C. trachomatis; Chlamydia screening; Pregnant women