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Should Asymptomatic Men Be Included in Chlamydia Screening Programs? Cost-Effectiveness of Chlamydia Screening Among Male and Female Entrants to a National Job Training Program

Blake, Diane R. MD*; Quinn, Thomas C. MD†‡; Gaydos, Charlotte A. DRPH

Sexually Transmitted Diseases: January 2008 - Volume 35 - Issue 1 - p 91-101
doi: 10.1097/OLQ.0b013e31814b86f5
Article

Objective: To compare the cost-effectiveness of various chlamydia screening strategies within a population of male and female youth entering a national job training program.

Study Design: Cost-effectiveness analysis of various chlamydia screening strategies among a cohort of 4000 female and male New England job training students. Strategies for women include (a) no screening, (b) universal endocervical DNA probe screening, (c) universal urine based NAAT screening, and (d) universal endocervical NAAT screening. Strategies for men include (a) no screening, (b) selective urine NAAT screening of leukocyte esterase (LE)-positive urines, and (c) universal urine-based NAAT screening.

Results: Universal endocervical NAAT screening of women and universal urine NAAT screening of men were the most effective and cost-effective strategies individually and in combination. Endocervical NAAT screening of women prevented 23 more cases of PID and saved $27,000 more than endocervical DNA probe screening. Likewise, universal urine NAAT screening of men prevented 21 more cases of PID in their female partners and saved $16,000 more than selective urine NAAT screening of LE positive men.

Conclusions: Use of a sensitive NAAT to screen both men and women for chlamydia upon entry to a National Job Training Program is cost-effective, cost-saving, and provides a public health opportunity to substantially reduce chlamydia infections among youth at risk for sexually transmitted diseases.

This cost-effectiveness analysis demonstrated that screening both male and female students for chlamydia upon entry to a national job training program was not only cost-effective but also cost saving. The combination screening strategy that was most cost-effective was to screen all entering male students for chlamydia with a urine nucleic acid amplification test and all entering female students with an endocervical nucleic acid amplification test.

From the *Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; †Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; and ‡National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

The authors thank Linda Lambrecht for her technical assistance, and the many technicians from The Johns Hopkins University Chlamydia Research Laboratory who assisted with this project. The authors also thank the job training program staff and students who participated in the study.

Supported by the National Institute of Allergy and Infectious Diseases (Grant No. 5 K23 AI01750), Child Health Research Grant from the Charles H. Hood Foundation, and by the University of Massachusetts Center for AIDS Research Clinical Investigation Core (AI42845).

The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases.

Correspondence: Diane R. Blake, MD, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail: Diane.Blake@umassmed.edu.

Received for publication April 28, 2006, and accepted July 2, 2007.

© Copyright 2008 American Sexually Transmitted Diseases Association