The Clinical and Economic Consequences of Screening Young Men for Genital Chlamydial Infection

• Published in: Sexually transmitted diseases Vol. 30; no. 2; pp. 99 - 106
• Main Authors: GINOCCHIO, RACHEL H. S., VEENSTRA, DAVID L., CONNELL, FREDERICK A., MARRAZZO, JEANNE M.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-02-2003; Lippincott; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Bacterial diseases; Bacterial diseases of the genital system; Bacteriological Techniques; Biological and medical sciences; Carboxylic Ester Hydrolases - urine; Chlamydia Infections - diagnosis; Chlamydia Infections - epidemiology; Chlamydia Infections - prevention & control; Chlamydia trachomatis - genetics; Chlamydia trachomatis - isolation & purification; Cost-Benefit Analysis; Decision Trees; Female; Genital Diseases, Male - diagnosis; Genital Diseases, Male - epidemiology; Genital Diseases, Male - prevention & control; Human bacterial diseases; Humans; Infectious diseases; Ligase Chain Reaction - methods; Male; Mass Screening - economics; Medical sciences; Medical screening; Men; Pelvic Inflammatory Disease - prevention & control; Prevalence; Sensitivity and Specificity; Sexually transmitted diseases; STD; Urine - microbiology; Costs; Male; Genital diseases; Chlamydia; Chlamydiales; Bacteria; Diagnosis; Male genital diseases; Cost efficiency analysis; Human; Leukocyte elastase; Urine; Bioassay; Chlamydiaceae; Serine endopeptidases; Enzyme; Medical screening; Male genital system; Infection; Peptidases; Ligase chain reaction; Health economy; Young adult; Bacteriosis; Hydrolases; Technique; Comparative study
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/00007435-200302000-00001

Background: Wide-scale application of urine-based screening of asymptomatic men for chlamydial infection has not been thoroughly assessed. Goal: The goal was to compare clinical and economic consequences of three strategies: (1) no screening, (2) screening with ligase chain reaction (LCR) assay of urine, and (3) prescreening urine with a leukocyte esterase test (LE) and confirming positives with LCR. Study Design: We used a decision analytic model. Results: At a chlamydia prevalence of 5%, the no screening cost was $7.44 per man screened, resulting in 522 cases of pelvic inflammatory disease (PID) per 100,000 men. LE-LCR was most cost-effective, preventing 242 cases of PID over no screening at an additional cost of $29.14 per male screened. The LCR strategy prevented 104 more cases of PID than LE-LCR but cost $22.62 more per male screened. For this to be more efficient than LE-LCR, the LCR assay cost needed to decline to ≤$18. Conclusion: At a chlamydia prevalence of 5%, LE-LCR is the most efficient use of resources. If LCR cost decreases or chlamydia prevalence increases, the LCR strategy is favored.