Screening females in juvenile detention for chlamydial cervicitis: A cost-minimization analysis

Abstract

PURPOSE: To compare the costs of different strategies of testing and treating chlamydia cervicitis in adolescent females in the juvenile justice system.METHODS: Using a decision analytic model, we compared 5 strategies: 1) do nothing; 2) treat everyone with a single 1 gm dose of azithromycin; 3) screen for current symptoms or history of a sexually transmitted disease (SH) and treat those who have a positive screen; 4) screen with urine ligase chain reaction (LCR) and treat those who have a positive test; 5) screen with cervical LCR and treat those who have a positive test. Chlamydia prevalence and SH screen test characteristics were determined from a cohort study conducted at a juvenile detention center. Treatment and testing costs were taken from the cost accounting system at an urban teaching facility. LCR test characteristics, treatment efficacy, and complication (pelvic inflammatory disease, infertility, chronic pelvic pain, and ectopic pregnancy) rates and costs were derived from the literature. Future costs were discounted at a 3% annual rate in the base case.RESULTS: In this cohort (241 females, 59.8% African American, 40% Caucasian, mean age 14.8 years) with a prevalence of chlamydia of 16.8%, empiric treatment (Strategy 2) was the least expensive strategy, but screening with urine LCR (Strategy 4) was only minimally more expensive (see table). Although changes in a number of variables affected the total costs, only changes in chlamydia prevalence and the pelvic inflammatory disease rate would render strategies other than 2 or 4 to be preferred. For example, if the prevalence of chlamydia were between 0 and 3.5%, then doing nothing (Strategy 1) would be the least expensive strategy; between 3.5% and 5.6%, SH (Strategy 3) would be least expensive; between 5.6% and 16.4%, urine LCR (Strategy 4) would be least expensive; and if the prevalence of chlamydia were greater than 16.4%, then empiric therapy (Strategy 2) would be least expensive.CONCLUSION: In a detained adolescent female population, empiric treatment for chlamydia cervicitis or treatment based on urine LCR results are nearly equivalent in cost and are less costly than other strategies.