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Optimal resource allocation for curing Chlamydia trachomatis infection
among asymptomatic women at clinics operating on a fixed budget.
Sexually Transmitted Diseases 2002;29(11):703-709.
Tao G, Gift TL, Walsh CM, Irwin KL, Kassler WJ.
Abstract
GOAL: The goal was to determine the optimal strategy for screening coverage,
test selection, and treatment for infection in asymptomatic women for a given
family-planning-program budget. STUDY DESIGN: We developed a resource allocation
model to determine the optimal strategy using data from 5078 visits by women
universally screened for infection in a publicly funded family planning clinic
system in Philadelphia. We maximized the number of infected women cured from
the clinic perspective and maximized the cost-savings from the healthcare
system perspective. The model incorporated the following age distributions: <20
years (27%), 20 to 24 years (30%), and >24 years (43%), with prevalences
of 10.6%, 6.9%, and 2.3%, respectively. We modeled two screening test assays
(DNA probe and ligase chain reaction [LCR] for cervical specimens) and two
treatments (doxycycline and azithromycin). The model allowed for different
test and treatment choices by age group. RESULTS: At the baseline annual
budget of $6 per visit, the strategy that maximized both the number of infected
women cured and cost savings would be to screen all women with DNA probe
and to treat all women with positive tests with azithromycin. This strategy
would result in 183 women cured at a cost-savings of $140,176. Sensitivity
analysis showed that the total budget had a great impact on the optimal strategy,
incorporating screening coverage, test selection, and treatment. CONCLUSIONS:
Using resource allocation models enables clinic managers operating with a
fixed budget to identify a strategy that maximizes the number of asymptomatic
women cured and cost savings when the clinic age distribution and age-specific
prevalences are known.