The impact of natural history parameters on the cost-effectiveness of Chlamydia trachomatis screening strategies.

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.