Cost and effectiveness of chlamydia screening among male military recruits: Markov modeling of complications averted through notification of prior female partners

Background: Despite rising rates of female screening, a high economic burden remains associated with Chlamydia infection from high rates of undetected asymptomatic disease and its associated sequelae of pelvic inflammatory disease (PID) and chronic pelvic pain (CP). Males comprise the majority of US military recruits and represent an ideal population in which to achieve identification and interruption of sexually transmitted infection among infected partners through mass tandem screening. Methods: We developed a static decision tree incorporating a calibrated Markov model to predict the differences in healthcare payer direct healthcare costs, cases of PID and CP averted among female partners of male recruits through implementation of either selective (aged 24 and younger) or universal recruit screening policies incorporating partner notification. Results: A policy of selective male screening added $10.30 in direct costs per recruit, whereas universal male screening added an additional $1.60. A policy of selective male screening yielded an incremental cost-effectiveness ratio of $3.7K per case of PID averted, and $7.3K per case of CP averted, whereas universal screening yielded an incremental cost-effectiveness ratio of $8.2K per additional case of PID and $16.4K per additional case of CP averted beyond selective screening. Neither policy was dominant, and results were qualitatively robust to single-variable and probabilistic sensitivity analysis. Conclusions: In consonance with other studies of mass tandem screening, we found both selective and universal male recruit screening cost-effective as compared with other interventions. Our results argue in favor of universal screening of male recruits for Chlamydia infection, linked to partner notification.