AN ECONOMIC-EVALUATION OF SCREENING FOR CHLAMYDIA-TRACHOMATIS IN ADOLESCENT MALES

Objective.-To assess the cost-effectiveness of identifying asymptomati c carriers of Chlamydia trachomatis among adolescent males. Design.-Co st-effectiveness analysis based on cohort analytic studies previously reported and average salaries and costs of medical care in Sweden. Set ting.-Adolescent males attending a primary care center for routine hea lth checks. Participants.-Estimates of costs and benefits are based on a cohort of 1 000 adolescent males and their female contacts. Interve ntion.-Screening with enzyme immunoassay (EIA), either on leukocyte es terase (LE)-positive urine samples (LE-EIA screening) or on all urine samples (EIA screening), was compared with no screening (no treatment or contact tracing). The effects of confirming positive EIA results wi th a blocking assay and alternative antibiotic regimens on the outcome of the screening strategies were also evaluated. Results.-Compared wi th no screening, the LE-EIA and EIA screening strategies reduced the o verall costs when the prevalence of chlamydial infection in males exce eded 2% and 10%, respectively. Enzyme immunoassay screening achieved a n overall cure rate that was 12.2% to 12.6% (95% confidence interval) better, but reduced the incremental savings by at least $2144 per cure d male, in comparison with LE-EIA screening. Confirmation of positive EIA results reduced the overall cost of the LE-EIA screening strategy when the prevalence of C trachomatis among males was less than 8%. Com pared with a 7-day course of doxycycline, a single oral dose of azithr omycin administered under supervision in the clinic improved the cure rates of both EIA and LE-EIA screening strategies by 15.1% to 16.3% an d 11.2% to 12.0%, respectively, while reducing the corresponding overa ll costs by 5% and 9%, respectively, regardless of the prevalence of c hlamydial infection in males. Conclusion.-The use of LE-EIA screening combined with treatment of positive cases with azithromycin was the mo st cost-effective intervention strategy focusing on asymptomatic male carriers of C trachomatis. Positive EIA results should be confirmed wh en screening low-risk populations.