WOMEN FOR CHLAMYDIA-TRACHOMATIS IN FAMILY-PLANNING CLINICS - THE COST-EFFECTIVENESS OF DNA AMPLIFICATION ASSAYS

Background: Highly sensitive and specific DNA amplification assays are available for use on cervical and urine specimens, These new tests ha ve the potential to identify more chlamydial infections than the commo nly used enzyme immunoassay and DNA probe tests, yet they are more exp ensive, This study sought to assess the cost effectiveness of cell cul ture, enzyme immunoassay (EIA), DNA probe (Pace 2), polymerase chain r eaction (PCR) of cervical and urine specimens, and ligase chain reacti on (LCR) of cervical and urine specimens as screening tools for Chlamy dia trachomatis in asymptomatic women younger than 30 years of age att ending family planning clinics. Study Design: Program costs; medical c ost savings of prevented sequelae in women, male sex partners, and inf ant; and number of prevented cases of pelvic inflammatory disease (PID ), neonatal infections, and male sex partner urethritis and epididymit is were modeled in a decision analysis conducted from a health care sy stem perspective. Results are expressed for a cohort of 18,000 women. Results: If no screening for C. trachomatis were conducted in Maryland , 497 cases of PID would develop, costing $2.2 million in future medic al costs, Use of EIA to detect chlamydial infection would prevent 240 cases of PID and save $887,000 over no screening, Alternatively, use o f DNA amplification assays on urine specimens would prevent up to an a dditional 66 cases and save $287,100 over EIA, Use of LCR on cervical specimens would prevent at least 13 additional cases of PLD over the u rine-based assays, but would cost $3,005 for each additional case prev ented, In women receiving routine pelvic examinations, LCR of cervical specimens would prevent the most disease and provide the highest cost savings, In women not receiving routine pelvic examinations, use of L CR on cervical specimens would prevent the most disease but would cost approximately $28,000 per additional case of PID prevented over DNA a mplification of urine. Conclusions: Compared with ELA screening, the s trategy with the lowest program costs, a screening strategy that combi nes use of DNA amplification on cervical specimens in women receiving pelvic examinations, and DNA amplification of urine in women with no m edical indications necessitating a pelvic examination, prevents the mo st cases of PID and provides the highest cost savings, With enhanced s ensitivity over the other diagnostic assays and with the use of noninv asive specimen collection, DNA amplification assays should be implemen ted as cost-effective components of a screening program for C. trachom atis.