Cost effectiveness analysis of a population based screening programme for asymptomatic Chlamydia trachomatis infections in women by means of home obtained urine specimens

Objectives: To evaluate the cost effectiveness of a systematic screening programme for asymptomatic Chlamydia trachomatis infections in a female inner city population. To determine the sensitivity of the cost effectiveness analysis to variation in the probability of developing sequelae. Methods: A decision tree was constructed to evaluate health effects of the programme, such as averted sequelae of chlamydial infection. Cost effectiveness from a societal perspective was estimated for screening by means of a ligase chain reaction on mailed, home obtained urine specimens, in a population with a C trachomatis test prevalence of 2.9%. An extensive sensitivity analysis was performed for the probability of sequelae, the percentage of preventable pelvic inflammatory disease (PID), and the discount rate. Results: The estimated net cost of curing one woman, aged 15–40 years, of a C trachomatis infection is US$1210. To prevent one major outcome (PID, tubal factor infertility, ectopic pregnancy, chronic pelvic pain, or neonatal pneumonia), 479 women would have to be screened. The net cost of preventing one major outcome is $15 800. Changing the probability of PID after chlamydial infection from 5% to 25% decreases the net cost per major outcome averted from $28 300 to $6380, a reduction of 78%. Results were less sensitive to variations in estimates for other sequelae. The breakeven prevalence of the programme ranges from 6.4% for the scenario with all probabilities for complications set at the maximum value to a prevalence of 100% for probabilities set at the minimum value. Conclusions: Systematic screening of all women aged 15–40 years for asymptomatic C trachomatis infections is not cost effective. Although the results of the analyses are sensitive to variation in the assumptions, the costs exceed the benefits, even in the most optimistic scenario.

[1]  P. Chen,et al.  [Chlamydia trachomatis infection in women with ectopic pregnancy]. , 1990, Zhonghua yi xue za zhi = Chinese medical journal; Free China ed.

[2]  S. Thompson,et al.  Pelvic Inflammatory Disease and Fertility: A Cohort Study of 1,844 Women with Laparoscopically Verified Disease and 657 Control Women with Normal Laparoscopic Results , 1992, Sexually transmitted diseases.

[3]  K. Holmes,et al.  Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. , 1996, New England Journal of Medicine.

[4]  G. Hart,et al.  Sexuality and health: the hidden costs of screening for Chlamydia trachomatis , 1999, BMJ.

[5]  Charlotte Gaydos,et al.  Screening for Chlamydia trachomatis in Asymptomatic Women Attending Family Planning Clinics: A Cost-Effectiveness Analysis of Three Strategies , 1998, Annals of Internal Medicine.

[6]  F. Skjeldestad,et al.  Should asymptomatic patients be tested for Chlamydia trachomatis in general practice? , 1990, The British journal of general practice : the journal of the Royal College of General Practitioners.

[7]  J C Jager,et al.  Economic evaluation of influenza vaccination. Assessment for The Netherlands. , 1999, PharmacoEconomics.

[8]  C. Henquet,et al.  Detection of Chlamydia trachomatis infection in urine samples from men and women by ligase chain reaction , 1995, Journal of clinical microbiology.

[9]  L. Bodin,et al.  Decreasing Incidences of Gonorrhea‐ and Chlamydia‐Associated Acute Pelvic Inflammatory Disease: A 25‐Year Study From an Urban Area of Central Sweden , 1996, Sexually transmitted diseases.

[10]  M. Parsonage,et al.  Discounting and health benefits. , 1992, Health economics.

[11]  H. Handsfield,et al.  Performance and Cost‐Effectiveness of Selective Screening Criteria for Chlamydia trachomatis Infection in Women: Implications for a National Chlamydia Control Strategy , 1997, Sexually transmitted diseases.

[12]  P. Mårdh,et al.  An economic evaluation of screening for Chlamydia trachomatis in adolescent males. , 1993, JAMA.

[13]  J. Sellors,et al.  Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. , 1988, Fertility and sterility.

[14]  S. Morré,et al.  Mailed, Home-Obtained Urine Specimens: a Reliable Screening Approach for Detecting Asymptomatic Chlamydia trachomatis Infections , 1999, Journal of Clinical Microbiology.

[15]  W. Cates,et al.  Genital chlamydial infections: epidemiology and reproductive sequelae. , 1991, American journal of obstetrics and gynecology.

[16]  F. Olesen,et al.  Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study , 1996, BMJ.

[17]  L Weström,et al.  Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. , 1980, American journal of obstetrics and gynecology.

[18]  L. Bouter,et al.  Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population , 2000, Sexually transmitted infections.

[19]  G. Ridgway,et al.  Comparison of two methods of screening for genital chlamydial infection in women attending in general practice: cross sectional survey , 1997, BMJ.

[20]  H. Verbrugh,et al.  Detection of Chlamydia trachomatis in male and female urine specimens by using the amplified Chlamydia trachomatis test , 1997, Journal of clinical microbiology.

[21]  R. Sweet,et al.  Prospective study of perinatal transmission of Chlamydia trachomatis. , 1986, JAMA.