Genç M, Mårdh A
Uppsala University Centre for STD Research, Sweden.
Ann Intern Med. 1996 Jan 1;124(1 Pt 1):1-7. doi: 10.7326/0003-4819-124-1_part_1-199601010-00001.
To assess the cost-effectiveness of identifying and treating asymptomatic female carriers of Chlamydia trachomatis.
Cost-effectiveness analysis based on previously reported cohort analytic studies and average salaries and costs of medical care in Sweden.
Women attending youth, family planning, and gynecology clinics.
1000 women and their male sex partners.
Screening with tissue cell culture, confirmed enzyme immunoassay, and DNA amplification assays based on either polymerase chain reaction or ligase chain reaction was compared with no screening (no treatment and no tracing of sexual contacts). The effect of antibiotic regimens on the outcome of the screening strategies was also evaluated.
When the prevalence of chlamydial infection exceeded 6%, screening of women with DNA amplification assay and treatment of positive patients with a single oral dose of azithromycin given under supervision in the clinic was the most cost-effective intervention strategy. At greater prevalences, screening with enzyme immunoassay also generated savings and improved the cure rates compared with no screening, but such screening was less cost-effective than screening with a DNA amplification assay. Compared with no intervention, tissue cell culture is cost-effective only when the prevalence of infection is greater than 14%. Compared with the azithromycin regimen, the standard 7-day, twice-daily doxycycline regimen resulted in significantly lower cure rates because of patients' poor compliance with this regimen.
For asymptomatic female carriers of C. trachomatis, screening with a DNA amplification assay combined with the single-dose azithromycin treatment of positive patients is the most cost-effective strategy when the prevalence is 6%. When the prevalence is lower than 6%, the decision to choose a competing strategy depends on the physician's view of the value of preventing an illness caused by untreated chlamydial infection.
评估识别和治疗沙眼衣原体无症状女性携带者的成本效益。
基于先前报道的队列分析研究以及瑞典的平均薪资和医疗成本进行成本效益分析。
在青年、计划生育和妇科诊所就诊的女性。
1000名女性及其男性性伴侣。
将基于组织细胞培养、确诊酶免疫测定以及聚合酶链反应或连接酶链反应的DNA扩增测定的筛查与不进行筛查（不治疗且不追踪性接触者）进行比较。还评估了抗生素治疗方案对筛查策略结果的影响。
当衣原体感染患病率超过6%时，采用DNA扩增测定法对女性进行筛查，并在诊所监督下给阳性患者单次口服阿奇霉素进行治疗，是最具成本效益的干预策略。在患病率更高时，与不进行筛查相比，采用酶免疫测定法进行筛查也能节省费用并提高治愈率，但这种筛查的成本效益低于采用DNA扩增测定法进行的筛查。与不进行干预相比，仅当感染患病率大于14%时，组织细胞培养才具有成本效益。与阿奇霉素治疗方案相比，标准的7天每日两次强力霉素治疗方案因患者对该方案依从性差而导致治愈率显著降低。
对于沙眼衣原体无症状女性携带者，当患病率为6%时，采用DNA扩增测定法进行筛查并对阳性患者采用单次剂量阿奇霉素治疗是最具成本效益的策略。当患病率低于6%时，选择竞争策略的决定取决于医生对预防未治疗的衣原体感染所致疾病价值的看法。
