Cost effectiveness of Chlamydia control services among family planning clients

Chlamydia trachomatis (CT) remains the most commonly reported infectious disease in the US. The pattern of CT transmission is difficult to interrupt due to its highly asymptomatic nature and high rates of reinfection. Many published cost-effectiveness models of CT screening suffer from major limitations, often ignoring reinfection. We developed a microsimulation model that incorporated the dynamics of infection acquisition, screening/diagnostic testing, treatment, partner management, and reinfection. We modeled 20,000 hypothetical FP/RH female and male clients and their partners through eight quarters or two years of CT exposure and treatment possibilities. This model examined several levels of partner management options—from no partner management, to scenarios with successful treatment from half of partners to all partners. This model incorporates the potential for reinfection among all male and female cases and allows for multiple partners. Screening all men and women with 100% partner management was the most effective way to prevent lower genital CT infection, resulting in approximately 6,700 fewer men and women infected with Chlamydia, 1,500 fewer women with chronic pelvic pain, and preventing over 10,000 PID cases, under 11,000 urethritis cases and 524 epididymitis cases. The costs averted by the prevention of negative health outcomes always exceeded program costs. Cost benefit ratios ranged from $1:$11 to $1:$35. Findings from this analysis demonstrate that the provision of Chlamydia control services are always cost-saving, and that more aggressive partner management strategies are a major factor in increasing a CT control program's cost-benefit ratio.