M. Genc et al., AN ECONOMIC-EVALUATION OF SCREENING FOR CHLAMYDIA-TRACHOMATIS IN ADOLESCENT MALES, JAMA, the journal of the American Medical Association, 270(17), 1993, pp. 2057-2064
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.