Chlamydia screening for pregnant women aged 16–25 years attending an antenatal service: a cost-effectiveness study

Objective: Determine the cost-effectiveness of screening all pregnant women aged 16–25 years for chlamydia compared with selective screening or no screening. Design: Cost effectiveness based on a decision model. Setting: Antenatal clinics in Australia. Sample: Pregnant women, aged 16–25 years. Methods: Using clinical data from a previous study, and outcomes data from the literature, we modelled the short-term perinatal (12-month time horizon) incremental direct costs and outcomes from a government (as the primary third-party funder) perspective for chlamydia screening. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and average cost-weights reported for hospitalisations classified according to the Australian refined diagnosis-related groups. Main outcome measures: Direct costs of screening and managing chlamydia complications, number of chlamydia cases detected and treated, and the incremental cost-effectiveness ratios were estimated and subjected to sensitivity analyses. Results: Assuming a chlamydia prevalence rate of 3%, screening all antenatal women aged 16–25 years at their first antenatal visit compared with no screening was $34,931 per quality-adjusted life-years gained. Screening all women could result in cost savings when chlamydia prevalence was higher than 11%. The incremental cost-effectiveness ratios were most sensitive to the assumed prevalence of chlamydia, the probability of pelvic inflammatory disease, the utility weight of a positive chlamydia test and the cost of the chlamydia test and doctor's appointment. Conclusion: From an Australian government perspective, chlamydia screening of all women aged 16–25 years old during one antenatal visit was likely to be cost-effective compared with no screening or selective screening, especially with increasing chlamydia prevalence. Tweetable abstract: Chlamydia screening for all pregnant women aged 16–25 years during an antenatal visit is cost effective.