SCREENING FOR CHLAMYDIA-TRACHOMATIS IN ASYMPTOMATIC WOMEN ATTENDING FAMILY-PLANNING CLINICS - A COST-EFFECTIVENESS ANALYSIS OF 3 STRATEGIES

Background: Screening women for Chlamydia trachomatis in family planni ng clinics is associated with a reduced incidence of chlamydial sequel ae. However, the question of whom to screen to maintain efficient use of resources remains controversial. Objective: To assess the cost-effe ctiveness of chlamydial screening done according to three sets of crit eria in asymptomatic women attending family planning clinics. Design: Cost-effectiveness analysis done by using a decision model with the pe rspective of a health care system. Model estimates were based on analy sis of cohort data, clinic costs, laboratory costs, and published data . Setting: Two family planning clinics in Baltimore, Mary land. Patien ts: 7699 asymptomatic women who presented between April 1994 and Augus t 1996. Intervention: Three screening strategies-screening according t o the criteria of the Centers for Disease Control and Prevention (CDC) , screening all women younger than 30 years of age, and universal scre ening-were retrospectively applied and compared. All women were tested with polymerase chain reaction. Measurements: Medical outcomes includ ed sequelae prevented in women, men, and infants. Total costs included screening program costs and future medical costs of all sequelae. The incremental cost-effectiveness ratios of each strategy were calculate d. Results: Without screening, 152 cases of pelvic inflammatory diseas e would occur at a cost of $676 000. Screening done by using the CDC c riteria would prevent 64 cases of pelvic inflammatory disease at a cos t savings of $231 000. Screening all women younger than 30 years of ag e would prevent an additional 21 cases of pelvic inflammatory disease and save $74 000. Universal screening would prevent an additional 6 ca ses of pelvic inflammatory disease but would cost $19 000 more than ag e-based screening, or approximately $3000 more per case of pelvic infl ammatory disease prevented. If the prevalence of C. trachomatis is mor e than 10.2% or if less than 88.5% of infections occur in women younge r than 30 years of age, universal screening provides the greatest cost savings. Conclusions: These results suggest that age-based screening provides the greatest cost savings of the three strategies examined. H owever, universal screening is desirable in some situations. In genera l, screening done by using any criteria and a highly sensitive diagnos tic assay should be part of any chlamydial prevention and control prog ram or health plan.