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The Impact of Natural History Parameters on the Cost-Effectiveness of Chlamydia trachomatis Screening Strategies

Hu, Delphine MD, MPH*; Hook, Edward W. III MD; Goldie, Sue J. MD, MPH*

Sexually Transmitted Diseases: July 2006 - Volume 33 - Issue 7 - p 428-436
doi: 10.1097/01.olq.0000200577.46261.b0
Article

Objective/Goal: To understand the potential impact of assumptions about the natural history of untreated Chlamydia trachomatis on the cost-effectiveness of screening strategies.

Study Design: Using a previously developed state-transition model, we explored how alternative assumptions about the natural history of disease following infection affect the estimated cost-effectiveness of screening for U.S. women. The analysis was conducted from a modified societal perspective and incorporated a lifetime analytic horizon.

Results: Different natural history assumptions affect cost-effectiveness outcomes. Assumptions about the combined risk of persistent and repeat infections have the greatest impact on the composition of optimal screening strategies, whereas assumptions about the risk of pelvic inflammatory disease most greatly influenced the magnitude of incremental cost-effectiveness ratios.

Conclusions: Priorities for future C trachomatis research should include better estimates of the risk of pelvic inflammatory disease, persistence, and repeat infection. Better delineation of these variables will permit improved evaluation of potential screening activities.

Using a mathematical model to simulate the disease course and outcomes of genital Chlamydia trachomatis infection in women, we explored the impact of natural history assumptions on the cost-effectiveness of routine screening and found that assumptions about the risk of pelvic inflammatory disease, persistence, and reinfection had an effect on the cost-effectiveness of screening strategies.

From the *Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts; and the †University of Alabama at Birmingham, Birmingham, Alabama

Grant support: By Agency for Health Care Policy and Research Fellowship Award (Dr. Hu).

Correspondence: Delphine Hu, MD, MPH, Harvard Initiative for Global Health, 104 Mt. Auburn Street, 3rd floor, Cambridge, MA 02138. E-mail: dhu@camail.harvard.edu.

Potential financial conflict of interest: Dr. Hook has received research support from Abbott Laboratories; Roche Molecular Systems, Inc.; Gen-Probe; and Becton, Dickinson, & Co.; and honoraria from Abbott Laboratories and Gen-Probe.

Received for publication June 13, 2005, and accepted October 12, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association