Screening for Gonorrhea, Chlamydia, and Hepatitis B

Tanksley, Audrey; Cifu, Adam S.

doi:10.1001/jama.2016.0223

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…These results are consistent with several prior cost-effective models that show increased cost of chlamydia screening, often offset by quality adjusted life (QALY) units and monetary conversion, with a notable decrease in associated morbidity [ 3 , 5 , 16 , 17 ]. Current US guidelines recommend screening for chlamydia in early pregnancy despite a distinct lack of evidence as to outcomes [ 18 ]. Since these recommendations were set knowing there is likely no net cost savings associated with chlamydia screening, the averted morbidity reported is of primary importance.…”

Section: Discussionmentioning

confidence: 99%

“…However, the United States Preventive Services Task Force (USPSTF) recommends screening for chlamydia in early pregnancy. Current guidelines also recommend screening in early pregnancy for other sexually transmitted infections (STIs) including HIV, gonorrhea and Hepatitis B [ 18 ]. Similarly, little evidence exists for clinical outcomes associated with screening for these STIs, particularly in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, little evidence exists for clinical outcomes associated with screening for these STIs, particularly in pregnancy. However given the low harm, high potential benefit and relatively low cost associated with screening for these STIs, as evidence by this model and other similar models, early screening for STIs during pregnancy has been determined to be an acceptable use of healthcare resources [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States

et al. 2017

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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 for Chlamydia trachomatis infection compared with no screening.MethodsWe developed a decision analysis model to estimate costs and health-related effects of screening pregnant women for C. 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 of C. 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 with C. trachomatis were calculated and compared.ResultsCost and benefit of screening relied on the prevalence of C. 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.ConclusionsConsidering a high prevalence region, prenatal screening for C. 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 with C. trachomatis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States

et al. 2017

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“…This finding is consistent with the literature affirming insufficient evidence for screening men with average risk. 4,19 Lines represent the fitted models for the three age groups, and shaded areas represent 95% confidence intervals. Limitations of our study include the previously mentioned inability to distinguish between diagnostic and screening Pap and chlamydia tests.…”

Section: Discussionmentioning

confidence: 99%

“…21 The USPSTF recently released new chlamydia screening recommendations. 19 Screening for chlamydia with a NAAT is recommended for all sexually active women aged 24 years or younger, and older women at risk. Canadian guidelines recommend screening at-risk groups (sexually active women and men aged 25 years or younger, older women at risk, and pregnant women) with NAATs for urine, urethral, or cervical specimens.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing

et al. 2017

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PURPOSE Many chlamydia infections are identified through screening, which is frequently offered to females concomitantly with cervical cancer screening. Recent cervical cancer screening guidelines recommend screening less frequently and starting later. We sought to evaluate the impact of the May 2012 Ontario, Canada, cervical cancer screening guideline change on Papanicolaou (Pap) and chlamydia trachomatis (chlamydia) testing and incidence.METHODS We extracted population-based physician billing claims data to identify Pap and chlamydia tests and public health surveillance data to identify chlamydia cases. We used interrupted time series analysis of quarterly data spanning 2 years before and after the guideline change and fitted segmented linear regression or rational functions to the outcomes using autoregressive integrated moving average models. Outcomes were stratified by sex and age group. RESULTSTwo years after the guideline change, we observed reduced chlamydia testing in females, with the greatest relative reduction (25.5%) among those aged 15 to 19 years. We also observed decreases in reported chlamydia incidence for females aged 15 to 19 years and 20 to 24 years (relative reductions of 16.8% and 14.4%, respectively). Chlamydia incidence remained the same for males, despite increased chlamydia testing.CONCLUSIONS Recent cervical cancer screening guideline changes in Ontario were associated with reduced chlamydia testing and reported new cases of chlamydia in females. Females aged 15 to 19 years, who are at high risk for chlamydia if sexually active, and who no longer warrant cervical cancer screening, were disproportionately affected. Females should be tested for chlamydia based on risk, regardless of need for Pap testing.

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Cost–Benefit Analysis of a Chlamydia trachomatis Vaccine Program in Adolescent Girls in the United States

Ditkowsky

Rahman

Hammerschlag

et al. 2017

Journal of the Pediatric Infectious Diseases Society

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Screening for Gonorrhea, Chlamydia, and Hepatitis B

Cited by 4 publications

References 6 publications

Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States

Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States

The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing

Cost–Benefit Analysis of a Chlamydia trachomatis Vaccine Program in Adolescent Girls in the United States

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