Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States. Issue 1 (December 2017) - Ditkowsky, Jared
Abstract Background Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the United States (U.S.) [1] and remains a major public health problem. We determined the cost- benefit of screening all pregnant women aged 15–24 forChlamydia trachomatis infection compared with no screening. Methods We developed a decision analysis model to estimate costs and health-related effects of screening pregnant women forC. trachomatis in a high burden setting (Brooklyn, NY). Outcome data was from literature for pregnant women in the 2015 US population. A virtual cohort of 6, 444, 686 pregnant women, followed for 1 year was utilized. Using outcomes data from the literature, we predicted the number ofC. trachomatis cases, associated morbidity, and related costs. Two comparison arms were developed: pregnant women who received chlamydia screening, and those who did not. Costs and morbidity of a pregnant woman-infant pair withC. trachomatis were calculated and compared. Results Cost and benefit of screening relied on the prevalence ofC. trachomatis ; when rates are above 16.9%, screening was proven to offer net cost savings. At a pre-screening era prevalence of 8%, a screening program has an increased expense of $124.65 million ($19.34/individual), with 328 thousand more cases of chlamydia treated, and significant reduction in morbidity. At a current estimate of prevalence, 6.7%, net expenditure for screening is $249.08 million ($38.65/individual), with 204.63 thousand cases of treated chlamydia and reduced morbidity. Conclusions Considering a high prevalence region, prenatal screening forC. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs. Screening programs are appropriate if the cost per individual is deemed acceptable to prevent the morbidity associated withC. trachomatis .