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Hum. Reprod. Advance Access originally published online on November 11, 2004
Human Reproduction 2005 20(2):425-432; doi:10.1093/humrep/deh608
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Human Reproduction vol. 20 no. 2 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Cost-effectiveness of Chlamydia antibody tests in subfertile women

A.A.A. Fiddelers1,4, J.A. Land2, G. Voss1, A.G.H. Kessels1 and J.L. Severens1,3

1 Department of Clinical Epidemiology and Medical Technology Assessment and 2 Department of Obstetrics and Gynaecology, Academisch Ziekenhuis Maastricht, PO Box 5800, 6202 AZ Maastricht and 3 Department of Health Organisation, Policy and Economics, University Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands

4 To whom correspondence should be addressed. Email: afi{at}kemta.azm.nl

BACKGROUND: For the evaluation of tubal function, Chlamydia antibody testing (CAT) has been introduced as a screening test. We compared six CAT screening strategies (five CAT tests and one combination of tests), with respect to their cost-effectiveness, by using IVF pregnancy rate as outcome measure. METHODS: A decision analytic model was developed based on a source population of 1715 subfertile women. The model incorporates hysterosalpingography (HSG), laparoscopy and IVF. To calculate IVF pregnancy rates, costs, effects, cost-effectiveness and incremental costs per effect of the six different CAT screening strategies were determined. RESULTS: pELISA Medac turned out to be the most cost-effective CAT screening strategy ({euro}15 075 per IVF pregnancy), followed by MIF Anilabsystems ({euro}15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; {euro}15 127) did not improve the cost-effectiveness of the single strategies. Sensitivity analyses showed that the results are robust for changes in the baseline values of the model parameters. CONCLUSIONS: Only small differences were found between the screening strategies regarding the cost-effectiveness, although pELISA Medac was the most cost-effective strategy. Before introducing a particular CAT test into clinical practice, one should consider the effects and consequences of the entire screening strategy, instead of only the diagnostic accuracy of the test used.

Key words: Chlamydia antibody testing/cost-effectiveness/decision model/diagnostic test


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