A COST-EFFECTIVENESS ANALYSIS OF SCREENING AND TREATMENT FOR CHLAMYDIA-TRACHOMATIS INFECTION IN ASYMPTOMATIC WOMEN

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.