Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S

Am J Prev Med. 2016 Aug;51(2):216-224. doi: 10.1016/j.amepre.2016.01.007. Epub 2016 Mar 4.


Introduction: In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective.

Methods: Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015.

Results: Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate.

Conclusions: The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care.

MeSH terms

  • Adolescent
  • Chlamydia Infections / diagnosis*
  • Chlamydia Infections / economics
  • Chlamydia trachomatis / isolation & purification
  • Cost-Benefit Analysis*
  • Female
  • Humans
  • Mass Screening / economics*
  • Patient Acceptance of Health Care*
  • Prevalence
  • Risk
  • United States
  • Young Adult