M. Genc et Pa. Mardh, A COST-EFFECTIVENESS ANALYSIS OF SCREENING AND TREATMENT FOR CHLAMYDIA-TRACHOMATIS INFECTION IN ASYMPTOMATIC WOMEN, Annals of internal medicine, 124(1), 1996, pp. 1-7
Objective: To assess the cost-effectiveness of identifying and treatin
g asymptomatic female carriers of Chlamydia trachomatis. Design: Cost-
effectiveness analysis based on previously reported cohort analytic st
udies and average salaries and costs of medical care in Sweden. Settin
g: Women attending youth, family planning, and gynecology clinics. Par
ticipants: 1000 women and their male sex partners. Intervention: Scree
ning with tissue cell culture, confirmed enzyme immunoassay, and DNA a
mplification as says based on either polymerase chain reaction or liga
se chain reaction was compared with no screening (no treatment and no
tracing of sexual contacts). The effect of antibiotic regimens on the
outcome of the screening strategies was also evaluated. Results: When
the prevalence of chlamydial infection exceeded 6%, screening of women
with DNA amplification assay and treatment of positive patients with
a single oral dose of azithromycin given under supervision in the clin
ic was the most cost-effective intervention strategy. At greater preva
lences, screening with enzyme immunoassay also generated savings and i
mproved the cure rates compared with no screening, but such screening
was less cost-effective than screening with a DNA amplification assay.
Compared with no intervention, tissue cell culture is cost-effective
only when the prevalence of infection is greater than 14%. Compared wi
th the azithromycin regimen, the standard 7-day, twice-daily doxycycli
ne regimen resulted in significantly lower cure rates because of patie
nts' poor compliance with this regimen. Conclusion: For asymptomatic f
emale carriers of C. trachomatis, screening with a DNA amplification a
ssay combined with the single-dose azithromycin treatment of positive
patients is the most cost-effective strategy when the prevalence is 6%
. When the prevalence is lower than 6%, the decision to choose a compe
ting strategy depends on the physician's view of the value of preventi
ng an illness caused by untreated chlamydial infection.