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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Jeanelle L Sheeder, BA and Catherine Stevens-Simon, MD. Adolescent Medicine, Department of Pediatrics, University of Colorado Health Sciences Center, 1056 East 19th Ave. Box B025, Denver, CO 80218, (303)764-8469, jeanelle.sheeder@uchsc.edu
Treatment of cervicitis poses an important public health dilemma in part, because it is not a specific indicator of infection. Most sexually transmitted cervical diseases (STDs) are asymptomatic and hormonal fluctuations can make uninfected cervices look inflamed. Nevertheless, concerns about the consequences of under-treatment typically over-shadow concerns about the consequences of over-treatment. Decision analysis was used to compare three treatments: 1) treat empirically and inform the patient that her partner needs treatment; 2) treat empirically, test for STDs, and base partner referral on the test results; 3) test for STDs and base treatment and partner referral on the test results. A comprehensive dynamic model that included the risk of reinfection and a utility equating the adverse effects of over-treatment with the risk of infection-mediated infertility due to under-treatment was studied. Excluding the costs of over-treatment, Treatment #1 yields the greatest cost savings both in human and financial terms. Including the costs of over-treatment however makes Treatment #3 optimal. Sensitivity analysis determined that the incidence of chlamydial cervicitis affects efficacy such that when the rate exceeds 35%, Treatment #2 nets the least morbidity. Treatment #1 becomes optimal only in chlamydia-endemic populations (>80% chlamydial cervicitis). This unique analysis demonstrates how the weight placed on the adverse consequences of over-treatment affects the incremental costs of the three treatments and will help providers weigh the costs and benefits of empiric treatment of this common clinical problem.
Learning Objectives:
Keywords: Chlamydia, Treatment Efficacy
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.