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Ann Intern Med. 2004 Oct 5;141(7):501-13.

Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis.

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  • 1Harvard School of Public Health, Boston, Massachusetts 02115-5924, USA.

Erratum in

  • Ann Intern Med. 2004 Nov 2;141(9):744.

Abstract

BACKGROUND:

Clinical guidelines have traditionally advised annual Chlamydia trachomatis screening for women younger than 25 years of age.

OBJECTIVE:

To assess the cost-effectiveness of recently proposed strategies for chlamydia screening.

DESIGN:

State transition simulation model; cost-effectiveness analysis.

DATA SOURCES:

Published literature.

TARGET POPULATION:

Sexually active U.S. women 15 to 29 years of age.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Modified societal.

INTERVENTIONS:

Four strategies targeted to 3 specific age groups (15 to 19 years, 15 to 24 years, and 15 to 29 years): 1) no screening, 2) annual screening for all women, 3) annual screening followed by 1 repeated test within 3 to 6 months after a positive test result, and 4) annual screening followed by selective semiannual screening for women with a history of infection.

OUTCOME MEASURES:

Clinical events (for example, pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and infertility), lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios.

RESULTS OF BASE-CASE ANALYSIS:

Annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection was the most effective and cost-effective strategy. It consistently had an incremental cost-effectiveness ratio less than 25,000 dollars per quality-adjusted life-year (QALY) compared with the next most effective strategy. When the indirect transmission effects of a 10-year screening program on the probability of infection in uninfected women (that is, per-susceptible rate of infection) were considered, all strategies became more cost-effective.

RESULTS OF SENSITIVITY ANALYSIS:

Results were sensitive to the annual incidence of chlamydia, probability of persistent infection, screening test costs, and costs of treating long-term complications. Each variable was associated with threshold values beyond which screening became cost-saving. In probabilistic analysis, annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection had an incremental cost-effectiveness ratio less than 50,000 dollars per QALY in 99% of simulations.

LIMITATIONS:

Uncertainty about the natural history of chlamydial infection and consideration of only the indirect transmission effects of C. trachomatis screening.

CONCLUSIONS:

Annual C. trachomatis screening for all women 15 to 29 years of age and selective targeting of those with a history of infection for semiannual screening is very cost-effective compared with other well-accepted clinical interventions.

PMID:
15466767
[PubMed - indexed for MEDLINE]
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