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PURPOSE: Clinical guidelines have traditionally advised annual Chlamydia trachomatis (CT) screening for women < 25 years age. However, recent data indicating a high rate of reinfection within six months of an initial infection has led to a reexamination of these guidelines, including the optimal screening strategy and target age range. The purpose of this study was to assess the cost-effectiveness of recently proposed strategies for chlamydia screening.
METHODS: We developed a mathematical model of the natural history of CT to simulate screening with urine-based nucleic acid amplification tests, diagnosis, and treatment in a cohort of 100,000 U.S. adolescent girls. The following strategies targeted to specific age groups (e.g., 15-19, 15-24, 15-29 years) were compared: (1) no screening, (2) annual screening for all women, (3) annual screening for all women followed by a single repeat test within 3 to 6 months of a positive test result, and (4) annual screening for all women followed by selective semiannual screening for women with a history of previous infection. In addition to the base case, we also evaluated the impact of including the indirect transmission effects of screening programs on the yearly incidence of CT infection and conducted probabilistic sensitivity analyses. Data were from prospective cohort studies, national databases, and published literature.
RESULTS: Screening for chlamydial infection prevented between 11% to 42% of all pelvic inflammatory disease and its sequelae. The most efficient and cost-effective strategy was screening all women ages annually and selectively targeting those with documented CT infection for semiannual surveillance. Relative to annual screening alone, this strategy targeted to women ages 15-24 years had an incremental cost-effectiveness ratio of $2,830 per QALY. In comparison, the same strategy extended to women ages 15-29 years was even more effective and cost $7,490 per QALY. When the indirect effects of screening on the yearly incidence of CT infection were considered, all strategies became more cost-effective. In probabilistic sensitivity analysis, annual screening in women ages 15-29 years followed by semiannual screening for those with documented infection had an incremental cost-effectiveness ratio less than $50,000 per QALY in 99% of simulations.
CONCLUSIONS: Screening all women age 15-29 annually for CT and selectively targeting those with a history of infection for semiannual screening is very cost-effective compared to other well-accepted clinical interventions.
See more of Oral Concurrent Session B - Screening in Chronic Disease
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)