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Background: The US Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC) recommend annual chlamydia and gonorrhea screening for sexually active young women < 25 years and for older women with elevated risk. Available data suggest that less than half of sexually active women < 25 years are screened annually for chlamydia. This analysis quantifies the potential impact of offering chlamydia and gonorrhea screening to all eligible women annually.
Methods: We used a previously-published transmission model of chlamydia screening in women < 25 years to estimate the impact of offering screening to 100% of eligible women aged 15-44 years (we assumed 95% would accept screening if offered). We determined from the model the change in chlamydia prevalence in both men and women expected to result from screening 95% of women < 25 years compared to no screening. This reduction in prevalence was applied to both chlamydia and gonorrhea to estimate the impact of a combined program. Chlamydia and gonorrhea prevalences were drawn from NHANES. Other parameters for societal-perspective costs, test performance, treatment likelihood and efficacy, and the likelihood and health utility impact of pelvic inflammatory disease (PID) and its sequelae were taken from the literature. These cost and impact estimates were applied to a U.S. birth cohort from ages 15-44 years. Future costs and benefits were discounted 3% per year.
Results: This analysis estimates that offering annual chlamydia and gonorrhea screening to all eligible women aged 15-44 years would reduce the population prevalence of chlamydia and gonorrhea by 32.1% in women and 10.4% in men compared to no screening. The net cost of the screening program would be $32,825 per QALY gained over no screening.
Conclusions: Fully implementing the USPSTF and CDC chlamydia and gonorrhea screening guidelines could have a beneficial impact on US population health.