Cost effectiveness analysis of a population based screening programme for asymptomatic Chlamydia trachomatis infections in women by means of home obtained urine specimens
Igm. Van Valkengoed et al., Cost effectiveness analysis of a population based screening programme for asymptomatic Chlamydia trachomatis infections in women by means of home obtained urine specimens, SEX TRANS I, 77(4), 2001, pp. 276-282
Objectives: To evaluate the cost effectiveness of a systematic screening pr
ogramme for asymptomatic Chlamydia, trachomatis infections in a female inne
r city population. To determine the sensitivity of the cost effectiveness a
nalysis to variation in the probability of developing sequelae.
Methods: A decision tree was constructed to evaluate health effects of the
programme, such as averted sequelae, of chlamydial infection. Cost effectiv
eness from a societal perspective was estimated for screening by means of a
ligase chain reaction on mailed, home obtained urine specimens, in a popul
ation with a C trachomatis test prevalence of 2.9%. An extensive sensitivit
y analysis was performed for the probability of sequelae, the percentage of
preventable pelvic inflammatory disease (PID), and the discount rate.
Results: The estimated net cost of curing one woman, aged 15-40 years, of a
C trachomatis infection is US$1210. To prevent one major outcome (PID, tub
al factor infertility ectopic pregnancy, chronic pelvic pain, or neonatal p
neumonia), 479 women would have to be screened. The net cost of preventing
one major outcome is $15 800. Changing the probability of PID after chlamyd
ial infection from 5% to 25% decreases the net cost per major outcome avert
ed from $28 300 to $6380, a reduction of 78%. Results were less sensitive t
o variations in estimates for other sequelae. The breakeven prevalence of t
he programme ranges from 6.4% for the scenario with all probabilities for c
omplications set at the maximum value to a prevalence of 100% for probabili
ties set at the minimum value.
Conclusions: Systematic screening of all women aged 15-40 years for asympto
matic C trachomatis infections is not cost effective. Although the results
of the analyses are sensitive to variation in the assumptions, the costs ex
ceed the benefits, even in the most optimistic scenario.