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Chlamydia screening of young women has health benefits and is cost effective

Chlamydia, a treatable sexually transmitted disease, affects more than 5 percent of sexually active female adolescents. Routine chlamydia screening of sexually active women 15 to 25 years of age has both health and cost benefits, concludes a recent review of the topic by researchers at the University of California, Los Angeles, and RAND.

Chlamydia is a bacterial infection that causes extensive inflammation and scarring of the genital tract. It increases women's risk for developing pelvic inflammatory disease (PID), tubal factor infertility, chronic pelvic pain, ectopic pregnancy, death from ectopic pregnancy, and HIV infection. Pregnant women who remain untreated are at greater risk for infant problems and deaths. The Centers for Disease Control and Prevention (CDC) advocates screening for chlamydia, which in 60 to 70 percent of women is asymptomatic.

This review, which was supported by the Agency for Healthcare Research and Quality (HS09473), revealed that screening 100 percent of sexually active women aged 18 to 24 would prevent an estimated 140,113 cases of PID each year and result in a savings of $45 for every woman screened. Among women participating in the CDC's chlamydia screening program in one region, the annual rate of chlamydia test positivity declined 65 percent from 9.3 percent to 3.3 percent. Apparently, high cure rates (97 percent) with the antibiotic doxycycline can be achieved at a very low cost ($2 in the public sector and $8 in the private sector).

These findings, along with the development of a valid and feasible quality measure, justify the adoption of chlamydia screening of young women as recommended by the National Committee for Quality Assurance for inclusion in the Health Plan Employer Data and Information Set (HEDIS), note the authors of the review. HEDIS is the most widely used system for assessing managed care performance. The authors conclude that inclusion of this screening in the HEDIS measures will increase public awareness of the problem and may provide an incentive for managed care plans to substantially increase chlamydia screening rates.

See "Health and cost-benefits of chlamydia screening in young women," by Rita Mangione-Smith, M.D., M.P.H., June O'Leary, M.D., and Elizabeth A. McGlynn, Ph.D., in the July 1999 Sexually Transmitted Diseases, pp. 309-316.

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