Chlamydia trachomatis infections can lead to serious and costly sequelae. Because chlamydia is most often asymptomatic, many infected youth do not seek testing. Entry to a detention system provides an opportunity to screen and treat many at-risk youth.
The goal of this study was to determine the cost-effectiveness of screening male youth for chlamydia on entry to detention.
Incremental cost-effectiveness of 3 chlamydia screening strategies was compared for a hypothetical cohort of 4000 male youth per year: 1) universal chlamydia screening using a urine-based nucleic acid amplification test (NAAT), 2) selective NAAT screening of urine leukocyte esterase (LE)-positive urines, and 3) no screening. The model incorporated programmatic costs of screening and treatment and medical cost savings from sequelae prevented in infected males and female partners. The analysis was conducted from the healthcare system perspective.
Chlamydia prevalence in the sampled population of 594 was 4.8%, and the average number of female sexual partners/infected male was 1.6. Universal NAAT screening was the most cost-effective strategy, preventing 37 more cases of pelvic inflammatory disease (PID) and 3 more cases of epididymitis than selective screening and saving an additional $24,000. The analysis was sensitive to NAAT cost, LE sensitivity, rate of PID development, PID sequelae cost, and number of female partners. Universal screening remained the most cost saving for prevalence as low as 2.8% or higher.
Universal chlamydia screening of adolescent males on entry to detention was the most cost-effective strategy. Savings are primarily the result of the prevention of PID in recent and future partners of index males. Screening detained male youth using a urine-based NAAT provides a public health opportunity to significantly reduce chlamydia infections in youth at risk for sexually transmitted diseases.
A cost-effectiveness analysis of screening adolescent males for Chlamydia trachomatis upon entry to detention in Central Massachusetts found that universal screening with a nucleic acid amplification test was cost-effective. Savings were due primarily to preventing PID in past and future partners.
*Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; and the †Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
The authors thank Carol Simon for her help with cost estimates, 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 Gary Shostak for his assistance in coordination of the prevalence study at the Department of Youth Services, to the staff who assisted us at each site, and especially to the youth who participated in the study.
The project described was supported by Grant No. 5 K23 AI01750 from the National Institute of Allergy and Infectious Diseases. Its 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. Research support was also provided by a Child Health Research Grant from the Charles H. Hood Foundation and by the University of Massachusetts Center for AIDS Research Clinical Investigation Core (AI42845).
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 June 2, 2003,
revised September 12, 2003, and accepted September 17, 2003.