A Swedish cost-effectiveness analysis of community-based Chlamydia trachomatis PCR testing of postal urine specimens obtained at home

Abstract

Aims: A study was undertaken to assess the cost-effectiveness of identifying and treating asymptomatic carriers of Chlamydia trachomatis when using community-based testing of urine specimens obtained at home and mailed to a central laboratory. Methods: A total of 100 males and 100 females aged 20 - 24 living in Umeå were randomly sampled from the population registry. A societal cost-effective analysis was carried out, based on screening and medical care costs in Sweden. Results: With a participation rate of 55% (45% males and 65% females), the female screening became cost-saving as the C. trachomatis prevalence exceeded 5.1%, and the male screening became cost-saving with over 12.3% prevalence. Conclusion: Postal screening for C. trachomatis in an asymptomatic young population can be cost-effective only at prevalences higher than at present.

Keywords

Chlamydia trachomatis cost-effectiveness participation rate PCR population screening postal urine specimen prevalence.

Get full access to this article

View all access options for this article.

References

Mårdh P-A. Chlamydia epidemic, with special emphasis on European perspectives . In: Proceedings of the European Society for Chlamydia research , 1988. Stockholm, Sweden: Almqvist & Wiksell, 1988: 3 - 6.

Paavonen J. , Eggert-Kruse W. Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update 1999; 5: 433 - 47.

Paavonen J. , Lehtinen M. Chlamydial pelvic inflammatory disease. Hum Reprod Update 1996; 2: 519 - 29.

Plummer FA , Simonsen JN , Cameron DW , Ndinya-Achola JO , Kreiss JK , Gakinya MN , et al. Cofactors in male - female sexual transmission of human immunodeficiency virus type 1. J Infect Dis 1991; 163: 233 - 9.

Pimenta J. , Fenton K. Recent trends in Chlamydia trachomatis in the United Kingdom and potential for national screening. Eurosurveillance 2001 : 81 - 4.

Fenton KA , Korovessis C. , Johnson AM , McCadden A. , McManus S. , Wellings K. , et al. Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. Lancet 2001; 358: 1851 - 4.

Mertz KJ , Levine WC , Mosure DJ , Berman SM , Dorian KJ Trends in the prevalence of chlamydial infections. The impact of community-wide testing. Sex Transm Dis 1997; 24: 169 - 75.

Berglund T. Klamydia, gonorre och syfilis första halvåret [in Swedish]. Smittskydd 2001; 7: 84 - 5.

Novak D. , Jonsson M. , Boman J. , Karlsson R.

Is postal screening for C. trachomatis based on urine samples obtained at home a feasible method in Sweden?

Eur J Public Health 2003; submitted.

10.

Macleod J. , Rowsell R. , Horner P. , Crowley T. , Caul EO , Low N. , et al. Postal urine specimens: are they a feasible method for genital chlamydial infection screening? Br J Gen Pract 1999; 49: 455 - 8 .

11.

Ostergaard L. , Moller JK , Andersen B. , Olesen F. Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study. Br Med J 1996; 313: 1186 - 9.

12.

Stephenson J. , Carder C. , Copas A. , Robinson A. , Ridgway G. , Haines A.

Home screening for chlamydial genital infection: is it acceptable to young men and women?

Sex Transm Infect 2000; 76: 25 - 7.

13.

Ostergaard L. , Andersen B. , Olesen F. , Moller JK Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study. Br Med J 1998; 317: 26 - 7.

14.

Morre SA , Van Valkengoed IG , Moes RM , Boeke AJ , Meijer CJ , Van den Brule AJ Determination of Chlamydia trachomatis prevalence in an asymptomatic screening population: performances of the LCx and COBAS Amplicor tests with urine specimens . J Clin Microbiol 1999; 37: 3092-6.

15.

Drummond MF , Richardson WS , O'Brien BJ , Levine M. , Heyland D. Users' guides to the medical literature, XIII: How to use an article on economic analysis of clinical practice. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 1997; 277: 1552 - 7.

16.

Genc M. , Ruusuvaara L. , Mardh PA An economic evaluation of screening for Chlamydia trachomatis in adolescent males. JAMA 1993; 270: 2057-64.

17.

Howell MR , Gaydos JC , McKee KT, Jr. , Quinn TC , Gaydos CA Control of Chlamydia trachomatis infections in female army recruits: cost-effective screening and treatment in training cohorts to prevent pelvic inflammatory disease. Sex Transm Dis 1999; 26: 519 - 26.

18.

Washington AE , Arno PS , Brooks MA The economic cost of pelvic inflammatory disease . JAMA 1986; 255: 1735 - 8.

19.

Washington AE , Johnson RE , Sanders LL, Jr.

Chlamydia trachomatis infections in the United States. What are they costing us?

JAMA 1987; 257: 2070-2.

20.

Randolph AG , Washington AE Screening for Chlamydia trachomatis in adolescent males: a cost-based decision analysis. Am J Public Health 1990; 80: 545 - 50.

21.

Westrom L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138(Pt 2): 880 - 92.

22.

Trachtenberg AI , Washington AE , Halldorson S. A cost-based decision analysis for Chlamydia screening in California family planning clinics. Obstet Gynecol 1988; 71: 101 - 8.

23.

Schachter J. , Sweet R. , Grossman M. , Landers D. , Robbie M. , Bishop E. Experience with the routine use of erythromycin for chlamydial infections in pregnancy. N Engl J Med 1986; 314: 276 - 9.

24.

Statistics S. Consumer Price Index 1831 - 2000. Stockholm: SCB, 2001.

25.

Russell LB , Gold MR , Siegel JE , Daniels N. , Weinstein MC The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996; 276: 1172-7.

26.

Holmes KK , Johnson DW , Trostle HJ An estimate of the risk of men acquiring gonorrhea by sexual contact with infected females. Am J Epidemiol 1970 ; 91: 170 - 4.

27.

CMO Main report of CMO's expert advisory committee on Chlamydia trachomatis. London : Dept. of Health; 1998.

28.

Macleod J. , Smith GD Chlamydia screening can have high take-up rates if right methodology is used . Br Med J 1999; 319: 188 - 9.

29.

Novak D. , Edman AC , Jonsson M. , Karlsson RB The internet, a simple and convenient tool in Chlamydia trachomatis screening of young people. Euro Surveill 2003 ; 8: 171 - 6.

30.

Scholes D. , Stergachis A. , Heidrich FE , Andrilla H. , Holmes KK , Stamm WE Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334: 1362 - 6.

31.

Edgardh K. , Homström U. , Bygdeman S. , Sandström E. , Bäckman M. Asymptomatic teenage girls should be tested for chlamydial infection [in Swedish] . Lakartidningen 1987; 84: 1845-7.

32.

Rahm V. , Gnarpe A. , Rosen G. Chlamydial infection is common among teenage girls who seek contraceptive advice [in Swedish]. Lakartidningen 1986; 83: 615- 16.

33.

Kaufman RE , Wiesner PJ Nonspecific urethritis. N Engl J Med 1974; 291: 1175-7.