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November 3, 1993

An Economic Evaluation of Screening for Chlamydia trachomatis in Adolescent Males

Author Affiliations

From the Uppsala University Centre for STD Research (Drs Genç and Mårdh) and the Adolescent Health Care Unit (Dr Ruusuvaara), Department of Obstetrics and Gynaecology, Uppsala (Sweden) University.

JAMA. 1993;270(17):2057-2064. doi:10.1001/jama.1993.03510170047029

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)