Control of Chlamydia trachomatis infections in female army recruits: Cost-effective screening and treatment in training cohorts to prevent pelvic inflammatory disease

Context: Chlamydia trachomatis genitourinary infections in females can lead to serious and costly sequelae, Programs such as basic (initial entry) mil itary training with controlled points of entry offer an opportunity to scre en large cohorts of women at risk for infection. Objective: To assess the cost-effectiveness of three interventions for C. t rachomatis infections in women beginning Army training: 1) screening using urine ligase chain reaction (LCR) by age, 2) unrestricted testing using uri ne LCR, and 3) universal antibiotic treatment with azithromycin, Design: Cost-effectiveness analysis from a military perspective, Setting and Patients: A hypothetical cohort of 10,000 women who intended to complete at least 2 years of military service was studied. Analysis was ba sed on data from 13,204 female trainees screened for chlamydial infection a t Fort Jackson, SC. Outcomes: Program and training costs, cost of illness averted, and pelvic i nflammatory disease (PID) prevented were determined for a 1-year follow-up period. Using sensitivity analysis, outcomes over 2 years were studied. Results: At a 9.2% prevalence, no screening resulted in $220,900 in trainin g and sequelae costs and 276 cases of PID, Screening by age produced the lo west cost $217,600, over a 1-year period and prevented 222 cases of PID for a cost-savings of $15 per case of PID prevented. Universal testing prevent ed an additional 11 cases of PID at a cost of $226,400, or costing $800 per additional case of PID prevented over age-targeted screening. Universal tr eatment prevented an additional 32 cases of PID and cost $221,100, saving $ 167 per additional cases of PID prevented over universal screening. Over a 2-year period, universal treatment provided the highest cost-savings and pr evented the most disease. Conclusion: Screening by age provided a cost-savings to the Army over a 1-y ear period. Other organizations accessing large cohorts of young women coul d also benefit, even in the short term, from implementation of an age-based chlamydial screening program. Universal testing or universal treatment may be warranted in which long-term societal goals, such as maximum reduction of PID, are relevant.