Health Care Costs and Financing

Study documents cost-effectiveness of targeted chlamydia screening

Annual chlamydia screening of all sexually active women 15 to 29 years of age and semiannual screening of those with a history of chlamydial infection is the most effective and cost-effective screening strategy, concludes a study supported by the Agency for Healthcare Research and Quality (T32 HS00020). Genital infection with Chlamydia trachomatis, the most widespread bacterial sexually transmitted disease in the United States, can lead to pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, and infertility due to tubal scarring. Since most chlamydial infections are asymptomatic and are 100 percent curable if caught early, screening and early treatment are the most promising approaches to preventing infection-related problems.

Delphine Hu, M.D., M.P.H., and colleagues at the Harvard School of Public Health assessed the cost-effectiveness of four recently proposed strategies for chlamydia screening targeted to three age groups (15 to 19 years, 15 to 24 years, and 15 to 29 years) sexually active women: no screening, annual screening for all women, annual screening followed by one repeated test within 3 to 6 months after a positive test result, and annual screening followed by selective semiannual screening for women with a history of infection.

The researchers examined the impact of these strategies on clinical events (for example, PID, chronic pelvic pain, ectopic pregnancy, and infertility), lifetime costs, quality-adjusted life years (QALYs), and cost-effectiveness. Annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection consistently had a cost-effectiveness ratio less than $25,000 per QALY gained compared with the next most effective strategy.

See "Screening for Chlamydia trachomatis in women 15 to 29 years of age: A cost-effectiveness analysis," by Dr. Hu, Edward W. Hook III, M.D., and Sue J. Goldie, M.D., M.P.H., in the October 5, 2004, Annals of Internal Medicine 141, pp. 501-513.

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