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An Economic Evaluation of Screening for Chlamydia trachomatis in Adolescent Males

Mehmet Genç, MD, MSc; Leena Ruusuvaara, MD, PhD; Per-Anders Mårdh, MD, PhD
JAMA. 1993;270(17):2057-2064. doi:10.1001/jama.1993.03510170047029.
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Objective.  —To assess the cost-effectiveness of identifying asymptomatic carriers of Chlamydia trachomatis among adolescent males.

Design.  —Cost-effectiveness analysis based on cohort analytic studies previously reported and average salaries and costs of medical care in Sweden.

Setting.  —Adolescent males attending a primary care center for routine health checks.

Participants.  —Estimates of costs and benefits are based on a cohort of 1000 adolescent males and their female contacts.

Intervention.  —Screening with enzyme immunoassay (EIA), either on leukocyte esterase (LE)—positive urine samples (LE-EIA screening) or on all urine samples (EIA screening), was compared with no screening (no treatment or contact tracing). The effects of confirming positive EIA results with a blocking assay and alternative antibiotic regimens on the outcome of the screening strategies were also evaluated.

Results.  —Compared with no screening, the LE-EIA and EIA screening strategies reduced the overall costs when the prevalence of chlamydial infection in males exceeded 2% and 10%, respectively. Enzyme immunoassay screening achieved an overall cure rate that was 12.2% to 12.6% (95% confidence interval) better, but reduced the incremental savings by at least $2144 per cured male, in comparison with LE-EIA screening. Confirmation of positive EIA results reduced the overall cost of the LE-EIA screening strategy when the prevalence of C trachomatis among males was less than 8%. Compared with a 7-day course of doxycycline, a single oral dose of azithromycin administered under supervision in the clinic improved the cure rates of both EIA and LE-EIA screening strategies by 15.1% to 16.3% and 11.2% to 12.0%, respectively, while reducing the corresponding overall costs by 5% and 9%, respectively, regardless of the prevalence of chlamydial infection in males.

Conclusion.  —The use of LE-EIA screening combined with treatment of positive cases with azithromycin was the most cost-effective intervention strategy focusing on asymptomatic male carriers of C trachomatis. Positive EIA results should be confirmed when screening low-risk populations.(JAMA. 1993;270:2057-2067)


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