Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies

Abstract

Objective: Screening for Chlamydia trachomatis in the lower genital tract may contribute to the prevention of pelvic inflammatory disease in women. The purpose of this review was to critically appraise, and summarise studies of the cost effectiveness of screening for C trachomatis. Methods: A literature search was conducted on Medline and in Health Star from 1990-2000. Keywords were C trachomatis, screening, cost effectiveness. Bibliographies of reviewed articles were also searched. The population studied was asymptomatic sexually active women under 30 years of age in a primary care setting. The intervention assessed was screening for lower genital tract infection with C trachomatis and the outcomes studied were cases of C trachomatis detected, cases of PID prevented, and associated costs. Studies were assessed using the Drummond criteria for economic evaluations. They were assessed qualitatively as they were too heterogeneous to allow quantitative analysis. Results: 10 studies were included. All were modelled scenarios and all found screening to be more cost effective than simply testing symptomatic women, although all were based on probabilities that were assumed. Six of the studies focused on DNA based testing, three of them using urine. The models showed screening to be cost effective at prevalences of 3.1-10.0%, and cost saving (overtesting symptomatic women) at a prevalence as low as 1.1%, if age was used as a selection factor and DNA based tests were used in urine samples. Conclusions: At the prevalence of infection expected in the target population, all studies suggest screening is cost effective. However, the assumptions used in the models have been difficult to confirm and there is a need for more data, particularly on the risk of complications in women with asymptomatic lower tract infection. C hlamydia trachomatis is the most common, curable, bacterial sexually transmitted disease.1 It is a major cause of pelvic inflammatory disease (PID), which in turn is a major cause of infertility and ectopic pregnancy. 2-5The prevalence of lower tract infection with C trachomatis varies from 2-25% 6 7 and is highest in young people. Infection with C trachomatis places a considerable burden on health services throughout the developed world. 8 The infection is asymptomatic in 75% of women and at least 50% of men, 9 thus lower genital tract infection remains largely undetected.Current screening practices differ throughout Europe and North America. For example, in Sweden there is an active detection policy targeting women under 25, whereas in the United Kingdom there is no formal screening programme. 10Most of the evidence that supports screening for C trachomatis as a way of preventing PID is derived from epidemiological data.2 3 11 12 The only randomised controlled trial (RCT) of screening for C trachomatis was conducted in the United States 13 and demonstrated that selective screening reduced the incidence of PID by 56% during 1 year of follow up.A number of studies [14][15][16][17][18][19][20][21][22][23][24] ha...

Prevalencia de Chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes de colegios de la zona Sabana Centro de Cundinamarca, Colombia

“…Como lo recomiendan muchas organizaciones, esta debería ser una política de salud prioritaria dado su costoefectividad (8,23).…”

“…Las guías de los Centers for Disease Control and Prevention (CDC) de los Estados Unidos recomiendan la tamización con técnicas no invasivas para la detección de C. trachomatis en todas las mujeres embarazadas, así como una vez al año en aquellas menores de 25 años sexualmente activas, en tanto que las pruebas de detección de N. gonorrhoeae se recomiendan en mujeres asintomáticas de alto riesgo (9), lo cual ha demostrado ser una estrategia costo-efectiva (23).…”

REVIEW ARTICLE: Chlamydia trachomatis, a Hidden Epidemic: Effects on Female Reproduction and Options for Treatment

“…In women, the infection can ascend the reproductive tract and cause PID and ectopic pregnancies. 11 The development of disease sequelae in women following chlamydial infection is associated with ascension of Chlamydia from the lower reproductive tract into the upper reproductive tract. The mechanisms that lead to this ascension are not fully understood, neither is the rate at which this happens.…”

Genital Chlamydia trachomatis infections

“…nelle donne di età compresa tra i 15 e 1 24 anni, è passata dal 6.3%, prima dello screening, al 2.1% con un calo quindi, del 67% (127). Uno studio revisionale condotto da Honey et al (53) in cui gli outcome selezionati sono stati i casi di infezione diagnosticati, i casi di MIP pervenuti e i costi associati, ha dimostrato che lo screening è conveniente ed efficace con una prevalenza compresa tra 3.1% e 10% usando l'età come variabile di selezione e usando test di amplificazione di acidi nucleici su campioni di urina. Un altro recente lavoro (56) dimostra che lo screening annuale in donne di età compresa tra 15 e 29 anni in concomitanza con uno screening ogni 6 mesi nei soggetti con storia di infezione risulta la strategia dal migliore rapporto costo-efficacia.…”

“…sembra essere responsabile di circa il 40% delle GEU mentre il 60% delle donne con infertilità tubarica presenta evidenza sierologica di pregressa infezione da C.t. (53). Anticorpi anti-Chlamydia sono stati trovati nell'80% di donne infertili con danno tubarico e nel 40% di donne infertili con tube non danneggiate (94,105).…”