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Cost and Effectiveness of Chlamydia Screening Among Male Military Recruits: Markov Modeling of Complications Averted Through Notification of Prior Female Partners

Nevin, Remington L. MD, MPH*; Shuping, Eric E. MD, MPH; Frick, Kevin D. MA, PhD; Gaydos, Joel C. MD, MPH§; Gaydos, Charlotte A. MPH, DrPH

Sexually Transmitted Diseases: August 2008 - Volume 35 - Issue 8 - p 705-713
doi: 10.1097/OLQ.0b013e31816d1f55

Background: Despite rising rates of female screening, a high economic burden remains associated with Chlamydia infection from high rates of undetected asymptomatic disease and its associated sequelae of pelvic inflammatory disease (PID) and chronic pelvic pain (CP). Males comprise the majority of US military recruits and represent an ideal population in which to achieve identification and interruption of sexually transmitted infection among infected partners through mass tandem screening.

Methods: We developed a static decision tree incorporating a calibrated Markov model to predict the differences in healthcare payer direct healthcare costs, cases of PID and CP averted among female partners of male recruits through implementation of either selective (aged 24 and younger) or universal recruit screening policies incorporating partner notification.

Results: A policy of selective male screening added $10.30 in direct costs per recruit, whereas universal male screening added an additional $1.60. A policy of selective male screening yielded an incremental cost-effectiveness ratio of $3.7K per case of PID averted, and $7.3K per case of CP averted, whereas universal screening yielded an incremental cost-effectiveness ratio of $8.2K per additional case of PID and $16.4K per additional case of CP averted beyond selective screening. Neither policy was dominant, and results were qualitatively robust to single-variable and probabilistic sensitivity analysis.

Conclusions: In consonance with other studies of mass tandem screening, we found both selective and universal male recruit screening cost-effective as compared with other interventions. Our results argue in favor of universal screening of male recruits for Chlamydia infection, linked to partner notification.

A study of the cost-effectiveness of screening male military recruits for infection with Chlamydia trachomatis found adverse events could be prevented among female partners at reasonable cost-effectiveness through notification.

From the *Army Medical Surveillance Activity, Silver Spring, Maryland; †Ireland Army Community Hospital, Ft. Knox, Kentucky; ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; §Department of Defense Global Emerging Infections Surveillance and Response System, Silver Spring, Maryland; and ∥Johns Hopkins Medical Institutions, Baltimore, Maryland

Portions of this article were previously presented at the 11th International Symposium on Human Chlamydial Infections, Niagara-on-the-Lake, Canada, June 18–23, 2006, and published in Chlamydial Infections: Proceedings of the Eleventh International Symposium on Human Chlamydial Infections. International Chlamydia Symposium, San Francisco, CA, pp 477-480.

This work was conducted as part of the authors’ regular duties.

The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting true views of the Department of the Army, the Department of Defense, or the Johns Hopkins Medical Institutions.

Correspondence: Remington L. Nevin, MD, MPH, Army Medical Surveillance Activity, 2900 Linden Lane, Suite 200, Silver Spring, MD 20910. E-mail:

Received for publication October 31, 2007, and accepted February 10, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association