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The cost effectiveness of screening for genital Chlamydia trachomatis infection in Australia

Silke Walleser A D , Glenn Salkeld B and Basil Donovan B C

A NHMRC Clinical Trials Centre, University of Sydney, NSW 2050, Australia.

B STEP (Screening Test Evaluation Program) School of Public Health, University of Sydney, NSW 2006, Australia.

C National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney, NSW 2001, Australia.

D Corresponding author. Email:

Sexual Health 3(4) 225-234
Submitted: 6 March 2006  Accepted: 13 October 2006   Published: 17 November 2006


Background: In Australia, there is no published study on the cost effectiveness of screening for chlamydia. The aim of this study was to examine the cost effectiveness of a hypothetical screening programme for chlamydia based on annual opportunistic testing of all women 25 years of age or younger consulting a general practitioner, compared with no screening. Methods: A decision–analytic modelling approach was used to determine the incremental cost effectiveness ratio (ICER) of screening compared with no screening over 25 years. The analysis measured Australian health-care costs and benefits were assessed in terms of quality-adjusted life years (QALYs). Results: The analysis resulted in a cost per QALY of $2968 for screening. One-way sensitivity analyses on all variables, and multi-way sensitivity analyses on some variables, showed a wide range for the cost effectiveness, from dominance (where screening is effective and saves money overall) to an ICER of $67 715 per QALY. Conclusions: The results indicate that annual opportunistic screening for chlamydia in women under 25 is a potentially worthwhile undertaking. However, the analysis also highlights uncertainties around the natural history of chlamydia and the effectiveness of chlamydia screening. Given these uncertainties, the need for further primary data collection in these areas becomes apparent.


[1]  National Centre in HIV Epidemiology and Clinical Research. HIV/AID, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2005. Sydney: The University of NSW; 2005.

[2]  Chen MY Donovan B 2004 Genital Chlamydia trachomatis infection in Australia: epidemiology and clinical implications. Sex Health 1 3 Suppl 189 96 doi:10.1071/SH04027 Pubmed Abstract

[3]  Bowden FJ Tabrizi SN Garland SM Fairley CK 2002 MJA practice essentials: sexually transmitted infections: new diagnostic approaches and treatments. Med J Aust 176 551 7 Pubmed Abstract

[4]  Nelson HD Helfand M 2001 Screening for chlamydial infection. Am J Prev Med 20 3 Suppl 95 107 doi:10.1016/S0749-3797(01)00253-7 Pubmed Abstract

[5]  Simms I Stephenson J 2000 Pelvic inflammatory disease epidemiology: what do we know and what do we need to know? Sex Transm Infect 76 2 80 7 doi:10.1136/sti.76.2.80 Pubmed Abstract

[6]  Heal C Jones B Veitch C Lamb S Hodgens S Browning S Butler H Carey M 2002 Screening for chlamydia in general practice. Aust Fam Physician 31 8 779 82 Pubmed Abstract

[7]  Chen MY Donovan B 2005 Changes in testing methods for genital Chlamydia trachomatis in New South Wales, Australia, 1999–2002. Sex Health 2 251 3

[8]  Egger M Low N Smith GD Lindblom B Herrmann B 1998 Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. BMJ 316 1776 80
Pubmed Abstract

[9]  Hillis SD Nakashima A Amsterdam L Pfister J Vaughn M Addiss D et al 1995 The impact of a comprehensive chlamydia prevention program in Wisconsin. Fam Plann Perspect 27 3 108 11 doi:10.2307/2136107 Pubmed Abstract

[10]  Herrmann BF Johansson AB Mardh P-A 1991 A retrospective study of efforts to diagnose infections by Chlamydia trachomatis in a Swedish county. Sex Transm Dis 18 4 233 7 Pubmed Abstract

[11]  Scholes D Stergachis A Heidrich FE Andrilla H Holmes KK Stamm WE 1996 Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 334 21 1362 6 doi:10.1056/NEJM199605233342103 Pubmed Abstract

[12]  The national strategy for sexual health and HIV. London: Department of Health; 2001.

[13]  Centers for Disease Control and Prevention 2002 Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep 51 1 84 No. RR-6

[14]  Chlamydia strategy for Victoria 2001–2004. Melbourne: Victorian Government Department of Human Services, Public Health Division; 2001.

[15]  Clinical Guidelines for the Management of sexually transmissible infections among priority populations. Sydney: The Royal Australasian College of Physicians – Adult Medicine Division – Australasian Chapter of Sexual Health Medicine; 2004.

[16]  Hollblad-Fadiman K Goldman SM 2003 American College of Preventive Medicine practice policy statement: screening for Chlamydia trachomatis. Am J Prev Med 24 3 287 92
doi:10.1016/S0749-3797(02)00636-0 Pubmed Abstract

[17]  Honey E Augood C Templeton A Russell I Paavonen J Mardh PA et al 2002 Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies. Sex Transm Infect 78 6 406 12 doi:10.1136/sti.78.6.406 Pubmed Abstract [see comment]

[18]  Golden MR Schillinger JA Markowitz LE St. Louis ME 2000 Duration of untreated genital infections with Chlamydia trachomatis – a review of the literature. Sex Transm Dis 27 6 329 37 Pubmed Abstract

[19]  Hu D Hook EW Goldie SJ 2004 Screening for Chlamydia trachomatis in Women 15 to 29 years of age: a cost-effectiveness analysis. Ann Intern Med 141 501 13 Pubmed Abstract

[20]  Lau C-Y Qureshi AK 2002 Azithromycin versus doxycycline for genital chlamydial infections – a meta-analysis of randomized clinical trials. Sex Transm Dis 29 9 497 502 Pubmed Abstract

[21]  Chen MY Ryder N Donovan B 2004 Completeness and timeliness of treatment for chlamydia within a sexual health service. Int J STD AIDS 15 762 4 doi:10.1258/0956462042395113 Pubmed Abstract

[22]  Beigi RH Wiesenfeld HC 2003 Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am 30 777 93 doi:10.1016/S0889-8545(03)00088-3 Pubmed Abstract

[23]  Molano M Meijer CJLM Weiderpass E Arslan A Posso H Franceschi S et al 2005 The natural course of Chlamydia trachomatis infection in asymptomatic Colombian women: a 5-year follow-up study. J Infect Dis 191 907 16 doi:10.1086/428287 Pubmed Abstract

[24]  Stratton KR , Durch JS , Lawrence RS . Vaccines for the 21st century: a tool for decisionmaking. Washington, DC: National Academy Press; 2000.

[25]  Chen MY Pan Y Britt H Donovan B 2006 Trends in clinical encounters for pelvic inflammatory disease and epididymitis in a national sample of Australian general practices. Int J STD AIDS 17 384 6

[26]  van Valkengoed IG Postma MJ Morre SA van den Brule AJ Meijer CJ Bouter LM Boeke AJ 2001 Cost effectiveness analysis of a population based screening programme for asymptomatic Chlamydia trachomatis infections in women by means of home obtained urine specimens. Sex Transm Infect 77 4 276 82
doi:10.1136/sti.77.4.276 Pubmed Abstract [see comment]

[27]  Genc M Mardh A 1996 A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women. Ann Intern Med 124 1 1 7 Pubmed Abstract

[28]  Westrom L Joesoef R Reynolds G Hagdu A Thompon SE 1992 Pelvic inflammatory disease and fertility – a cohort study of 1 844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 19 4 185 92 Pubmed Abstract

[29]  Australian Institute of Health and Welfare (AIHW). Australia’s Mothers and babies 2002. Canberra: AIHW; 2003.

[30]  Australian Government – Department of Health and Ageing. Schedule of pharmaceutical benefits for approved pharmacists and medical practitioners. Canberra: Commonwealth of Australia; 2004.

[31]  Australian Government – Department of Health and Ageing. Medicare Benefits Schedule Book. Canberra: Commonwealth of Australia; 2004.

[32]  National Hospital Cost Data collection: Cost weights for AR-DRG version 4.2., round 7 (2002–03), public sector. Canberra: Department of Health; 2004. Available online at: [verified November 2006].

[33]  Clinical profiles for public hospitals, AR-DRG v 5.0, Australia, 2000–01 Canberra: Commonwealth of Australia, Department of Health and Ageing; 2005.

[34]  Ward B Rodger AJ Jackson TJ Ward B Rodger AJ Jackson TJ 2006 Modelling the impact of opportunistic screening on the sequelae and public healthcare costs of infection with Chlamydia trachomatis in Australian women. Public Health 120 1 42 9 doi:10.1016/j.puhe.2005.03.002 Pubmed Abstract

[35]  George B , Harris A , Mitchell A . Cost-effectiveness analysis and the consistency of decision-making: evidence from pharmaceutical reimbursement in Australia 1991–1996. Working Paper 89. Melbourne: Centre for Health Program Evaluation, Monash University; 1999.

[36]  Health Matters ABC . Infertility – costs and legal issues. ABC Online; 2005. Available online at: [verified October 2006].

[37]  Ryan M 1998 Valuing psychological factors in the provision of assisted reproductive techniques using the economic instrument of willingness to pay. J Econ Psychol 19 179 204 doi:10.1016/S0167-4870(98)00003-8

[38]  Ratcliffe J . The economics of the IVF programme: a critical review. Working paper 20. Melbourne: Centre for Health Program Evaluation; 1992.

[39]  Kohl KS Markowitz LE Koumans EH 2003 Developments in the screening for Chlamydia trachomatis: a review. Obstet Gynecol Clin North Am 30 4 637 58 doi:10.1016/S0889-8545(03)00076-7 Pubmed Abstract

[40]  Australian Institute of Health and Welfare (AIHW). Cervical screening in Australia 1999–2000. Cancer Series No. 16. Canberra: AIHW; 2002.

[41]  van Valkengoed IG Morre SA van den Brule AJ Meijer CJ Bouter LM Boeke AJ 2004 Overestimation of complication rates in evaluations of Chlamydia trachomatis screening programmes–implications for cost-effectiveness analyses. Int J Epidemiol 33 2 416 25 doi:10.1093/ije/dyh029 Pubmed Abstract [see comment]

[42]  Wiesenfeld HC Hillier SL Krohn MA Amortegui A Heine RP Landers DV Sweet RL 2002 Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol 100 3 456 63 doi:10.1016/S0029-7844(02)02118-X Pubmed Abstract

[43]  Wolner-Hanssen P 1995 Silent pelvic inflammatory disease: is it overstated? Obstet Gynecol 86 3 321 5 doi:10.1016/0029-7844(95)00177-S Pubmed Abstract

[44]  Barratt A Irwig L Glasziou P Cumming RG Raffle A Hicks N Gray JA Guyatt GH 1999 Users’ guide to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-based medicine working group. JAMA 281 2029 34 doi:10.1001/jama.281.21.2029 Pubmed Abstract

[45]  Honey E Templeton A 2002 Prevention of pelvic inflammatory disease by the control of C. trachomatis infection. Int J Gynaecol Obstet 78 257 61 doi:10.1016/S0020-7292(02)00185-6 Pubmed Abstract

[46]  Welte R Postma M Leidl R Kretzschmar M Welte R Postma M et al 2005 Costs and effects of chlamydial screening: dynamic versus static modeling. Sex Transm Dis 32 8 474 83 doi:10.1097/ Pubmed Abstract

[47]  LaMontagne D Fenton KA Randall S Anderson S Carter P 2004 Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex Transm Infect 80 335 41 doi:10.1136/sti.2004.012856 Pubmed Abstract

[48]  Watson EJ Templeton A Russell I Paavonen J Mardh PA Stary A Pederson BS 2002 The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. J Med Microbiol 51 1021 31 Pubmed Abstract

[49]  Walker CK Kahn JG Washington AE Peterson HB Sweet RL 1993 Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy. J Infect Dis 168 969 78 Pubmed Abstract

[50]  Chen MY Fairley CK Donovan B 2005 Discordance between trends in chlamydia notifications and hospital admission rates for chlamydia related diseases in New South Wales, Australia. Sex Transm Infect 81 318 22

[51]  Ness RB Soper DE Holley RL Peipert J Randall H Sweet RL et al 2002 Effectiveness of inpatiet and outpatient treatment strategies for women with pelvic inflammatory disease: results from the pelvic inflammatory disease evaluation and clinical health (PEACH) randomized trial. Am J Obstet Gynecol 186 929 37
doi:10.1067/mob.2002.121625 Pubmed Abstract

[52]  Buchan H Vessey M Goldacre M Fairweather J 1993 Morbidity following pelvic inflammatory disease. Br J Obstet Gynaecol 100 558 62

[53]  Safrin S Schachter J Dahrouge D Sweet RL 1992 Long-term sequelae of acute pelvic inflammatory disease – a retrospective cohort study. Am J Obstet Gynecol 166 4 1300 5
Pubmed Abstract

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