Howell M R, Gaydos J C, Quinn T C, Gaydos C A
Johns Hopkins University, Division of Infectious Diseases, , Baltimore, Maryland 21205, USA.
Am J Prev Med. 2000 Oct;19(3):160-6. doi: 10.1016/s0749-3797(00)00202-6.
Screening women for genital Chlamydia trachomatis at entry to military service provides an opportunity to reduce costs associated with sequelae of this infection. However, financial responsibility for screening may be debated. More than 50% of recruits return to civilian life within 2 years. The military and the civilian health care systems would both benefit from a screening program.
To assess the cost-effectiveness and relative cost savings to the military and civilian health sectors of three screening strategies for U.S. Army female recruits for C. trachomatis using urine ligase chain reaction: screening all recruits, screening recruits aged < or = 25 years, and no screening.
We applied a decision analytic model. Cost factors included screening, lost military training, morbid pelvic inflammatory disease, and other sequelae. Using a 5-year analytic horizon, we conducted analyses from military and civilian perspectives.
Screening 10,000 female army recruits would cost 193,500 dollars and prevent 282 cases of sequelae, with a projected savings of 53,325 dollars to the military and 505,053 dollars to the civilian sector. From a military perspective, screening women aged < or = 25 years provided the highest cost savings. Screening all female recruits incurred an incremental cost of $1199 per sequela prevented. From a civilian perspective, screening all recruits offered the greatest cost savings.
Screening female Army recruits for C. trachomatis offers substantial savings in health care costs for both the military and civilian health care systems. Relative financial benefit derived from recruit screening is disproportionate; greatest cost savings are enjoyed by the civilian sector.
在女性新兵入伍时对其进行生殖道沙眼衣原体筛查，为降低该感染后遗症相关费用提供了契机。然而，筛查的经济责任可能存在争议。超过50%的新兵会在2年内重返平民生活。军事和民用医疗系统都将从筛查项目中受益。
评估采用尿液连接酶链反应对美国陆军女性新兵进行沙眼衣原体三种筛查策略（筛查所有新兵、筛查年龄≤25岁的新兵、不进行筛查）对军事和民用卫生部门的成本效益及相对成本节约情况。
我们应用了决策分析模型。成本因素包括筛查、军事训练损失、严重盆腔炎及其他后遗症。采用5年分析期限，从军事和民用角度进行分析。
筛查10000名陆军女性新兵将花费193500美元，预防282例后遗症，预计可为军事部门节省53325美元，为民用部门节省505053美元。从军事角度看，筛查年龄≤25岁的女性新兵成本节约最高。筛查所有女性新兵每预防一例后遗症产生的增量成本为1199美元。从民用角度看，筛查所有新兵成本节约最大。
对陆军女性新兵进行沙眼衣原体筛查可为军事和民用医疗系统大幅节省医疗费用。新兵筛查带来的相对经济收益不成比例；民用部门获得的成本节约最大。
