Benefit of adjunct universal rectal screening for Chlamydia genital infections in women attending Canadian sexually transmitted infection clinics

Abstract

Adding universal rectal screening to urogenital screening should positively impact rectal Chlamydia trachomatis (CT) incidence in affected populations. A dynamic Markov model was used to evaluate costs and outcomes of three rectal CT screening strategies among women attending sexually transmitted infection clinics in Alberta, Canada: universal urogenital-only screening (UG-only), additional selected (exposure-based) rectal screening (UG+SR), and additional universal rectal screening (UG+UR). The model included two mutually exclusive health states: infected and susceptible. Additionally, the model included two rounds of transmission: male sex partners of women infected with rectal-only CT and female sex partners of those men. CT complications impacting patients' quality of life (QALY) were considered. Alberta and Canadian data were used to estimate model inputs. We used a health care perspective, a time period of 10 years, and a discount rate of 3% for analyses. Compared to UG-only screening, the incremental cost effectiveness ratios (ICERs) were CA$34,000 and CA$49,000 per QALY gained for UG+SR and UG+UR screening strategies, respectively. Compared to UG+SR, the ICER was CA$62,000 per QALY gained for the UG+UR strategy. Both adjunct selected and universal rectal screening strategies are cost effective compared to UG-only screening, and UG+UR screening is cost effective when compared to UG+SR screening.

Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women: A Multicenter Observational Study (FemCure)

“…This is because selective rectal testing policies result in many untested rectal infections that are coincidentally azithromycin-treated for vaginal CT [3, 6, 7]. Rectal testing is highly acceptable [4–6], and universal rectal testing has been found to be cost-effective in the STI clinic context [30]. Pooling of samples may contribute to reduced costs.…”

Evaluation of Chlamydia trachomatis screening from the perspective of health economics: a systematic review

“…Two studies were conducted on STD clinics ( 51 , 52 ), one in an abortion clinic ( 50 ), and another in multiple high-risk settings, including abortion clinics ( 49 ). These studies yielded quite different results as they used different comparators.…”

“…A study from the USA conducted in an STD clinic found that the self-obtained vaginal Aptima Combo 2 (AC2) strategy was the most cost-effective, savings $2384 per PID ( 51 ). Another Canadian STD clinic-based study found that adding rectal screening both universally and selectively to urogenital screening would be cost-effective if the CA$50,000 <WTP <CA$100,000 ( 52 ).…”

The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review

“…Another study showed that a community-based intervention in Sweden called ‘Chlamydia Monday’—consisting of the provision of information and increased availability of testing, treatment and contact tracing—was cost-effective [ 59 ]. The last study focused on rectal chlamydia trachomatis screening as an add-on to female urogenital screening in STI clinics in Canada, and highlighted that selected and universal rectal screening are cost-effective compared to universal urogenital-only screening strategies [ 60 ].…”