Hu Delphine, Hook Edward W, Goldie Sue J
Harvard School of Public Health, Boston, Massachusetts 02115-5924, USA.
Ann Intern Med. 2004 Oct 5;141(7):501-13. doi: 10.7326/0003-4819-141-7-200410050-00006.
Clinical guidelines have traditionally advised annual Chlamydia trachomatis screening for women younger than 25 years of age.
To assess the cost-effectiveness of recently proposed strategies for chlamydia screening.
State transition simulation model; cost-effectiveness analysis.
Published literature.
Sexually active U.S. women 15 to 29 years of age.
Lifetime.
Modified societal.
Four strategies targeted to 3 specific age groups (15 to 19 years, 15 to 24 years, and 15 to 29 years): 1) no screening, 2) annual screening for all women, 3) annual screening followed by 1 repeated test within 3 to 6 months after a positive test result, and 4) annual screening followed by selective semiannual screening for women with a history of infection.
Clinical events (for example, pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and infertility), lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios.
RESULTS OF BASE-CASE ANALYSIS: Annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection was the most effective and cost-effective strategy. It consistently had an incremental cost-effectiveness ratio less than 25,000 dollars per quality-adjusted life-year (QALY) compared with the next most effective strategy. When the indirect transmission effects of a 10-year screening program on the probability of infection in uninfected women (that is, per-susceptible rate of infection) were considered, all strategies became more cost-effective.
Results were sensitive to the annual incidence of chlamydia, probability of persistent infection, screening test costs, and costs of treating long-term complications. Each variable was associated with threshold values beyond which screening became cost-saving. In probabilistic analysis, annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection had an incremental cost-effectiveness ratio less than 50,000 dollars per QALY in 99% of simulations.
Uncertainty about the natural history of chlamydial infection and consideration of only the indirect transmission effects of C. trachomatis screening.
Annual C. trachomatis screening for all women 15 to 29 years of age and selective targeting of those with a history of infection for semiannual screening is very cost-effective compared with other well-accepted clinical interventions.
临床指南传统上建议对25岁以下女性每年进行沙眼衣原体筛查。
评估最近提出的衣原体筛查策略的成本效益。
状态转换模拟模型；成本效益分析。
已发表的文献。
15至29岁有性行为的美国女性。
终身。
修正的社会视角。
针对3个特定年龄组（15至19岁、15至24岁和15至29岁）的4种策略：1）不筛查；2）对所有女性进行年度筛查；3）年度筛查，在检测结果呈阳性后3至6个月内进行1次重复检测；4）年度筛查，对有感染史的女性进行选择性半年筛查。
临床事件（如盆腔炎、慢性盆腔疼痛、异位妊娠和不孕症）、终身成本、质量调整生命预期以及增量成本效益比。
对15至29岁女性进行年度筛查，随后对有感染史的女性进行半年筛查是最有效且最具成本效益的策略。与次最有效的策略相比，其增量成本效益比始终低于每质量调整生命年25,000美元。当考虑10年筛查计划对未感染女性感染概率的间接传播效应（即易感感染率）时，所有策略的成本效益都更高。
结果对衣原体的年发病率持续感染概率、筛查检测成本以及治疗长期并发症的成本敏感。每个变量都与阈值相关，超过该阈值筛查将节省成本。在概率分析中，对15至29岁女性进行年度筛查，随后对有感染史的女性进行半年筛查，在99%的模拟中，增量成本效益比低于每质量调整生命年50,000美元。
衣原体感染自然史存在不确定性，且仅考虑了沙眼衣原体筛查的间接传播效应。
与其他广泛认可的临床干预措施相比，对所有15至29岁女性进行年度沙眼衣原体筛查，并对有感染史的女性进行选择性半年筛查具有很高的成本效益。
