Point-of-entry screening for C-trachomatis in female army recruits - Who derives the cost savings?

Background: Screening women fbr genital Chlamydia trachomatis at entry to m ilitary service provides an opportunity to reduce costs associated with seq uelae of this infection. However, financial responsibility for screening ma y be debated. More than 50% of recruits return to civilian life within 2 ye ars. The military and the civilian health care systems would both benefit f rom a screening program; Objective: To assess the cost-effectiveness and relative cost savings to th e military and civilian health sectors of three screening strategies for U. S. Army female recruits for C. trachomatis using urine ligase chain reactio n: screening all recruits, screening recruits aged less than or equal to 25 years, and no screening. Methods: We applied a decision analytic model. Cost factors included screen ing, lost military training, morbid pelvic inflammatory disease, and other sequelae. Using a 5-year analytic horizon, we conducted analyses from milit ary and civilian perspectives. Results: Screening 10,000 female army recruits would cost $193,500 and prev ent 282 cases of sequelae, with a projected savings of $53,325 to the milit ary and $505,053 to the civilian sector. From a military perspective, scree ning women aged less than or equal to 25 years provided the highest cost sa vings. Screening all female recruits incurred an incremental cost of $1199 per sequela prevented. From a civilian perspective, screening all recruits offered the greatest cost savings. Conclusions: Screening female Army recruits for C. trachomatis offers subst antial savings in health care costs for both the military and civilian heal th care systems. Relative financial benefit. derived from recruit screening is disproportionate; greatest cost savings are enjoyed by the civilian sec tor.