Cost-effectiveness analysis of Chlamydia trachomatis screening via internet-based self-collected swabs compared with clinic-based sample collection

Sex Transm Dis. 2011 Sep;38(9):815-20. doi: 10.1097/OLQ.0b013e31821b0f50.


Background: Although the Centers for Disease Control and Prevention have recommended population-wide Chlamydia trachomatis screening of sexually active women less than 26 years of age, more than half of sexually active young women are not routinely screened. A Website (IWTK,, was developed in 2004 to promote home-based sample collection.

Methods: A decision tree was designed to model a hypothetical cohort of 10,000 women per year who order an internet-based C. trachomatis screening kit. We compared the incremental cost-effectiveness of 2 screening strategies: self-sampling via the IWTK website, and traditional, clinic-based screening by the same cohort of women who used IWTK. Probabilities and costs were estimated for each node in the decision tree. Estimates were derived from primary data, published data, and unpublished health data.

Results: The internet-based screening strategy prevented 35.5 more cases of pelvic inflammatory disease and saved an additional $41,000 in direct medical costs as compared with the clinic-based screening strategy.

Conclusion: Our model estimates demonstrated that an internet-based, self-swab screening strategy was cost-effective compared with the traditional, clinic-based screening strategy. Assuming that the popularity of the use of the internet as a resource for information about healthcare and sexually transmitted infections leads to an increased use of IWTK, the public health benefit of this cost-effective strategy will be even greater.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Ambulatory Care Facilities
  • Chlamydia Infections / diagnosis*
  • Chlamydia Infections / economics
  • Chlamydia Infections / prevention & control
  • Chlamydia trachomatis / genetics
  • Chlamydia trachomatis / isolation & purification*
  • Cohort Studies
  • Cost-Benefit Analysis
  • DNA, Bacterial / genetics
  • Decision Trees
  • Female
  • Humans
  • Internet*
  • Mass Screening / economics*
  • Mass Screening / methods
  • Predictive Value of Tests
  • Prevalence
  • Public Health
  • Self Administration / economics
  • Sensitivity and Specificity
  • Vaginal Smears / economics


  • DNA, Bacterial