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Hum. Reprod. Advance Access published online on November 11, 2004
Human Reproduction, doi:10.1093/humrep/deh608
© 2004 by European Society of Human Reproduction and Embryology
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Received December 18, 2003
Revised August 5, 2004
Accepted October 15, 2004

Article

Cost-effectiveness of Chlamydia antibody tests in subfertile women

A.A.A. Fiddelers 1*, J.A. Land 2, G. Voss 1, A.G.H. Kessels 1, and J.L. Severens 3

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

* To whom correspondence should be addressed.
A.A.A. Fiddelers, E-mail: Afi{at}kemta.azm.nl


  Abstract

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 (15 075 per IVF pregnancy), followed by MIF Anilabsystems (15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; 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.

Keywords: Chlamydia antibody testing; cost-effectiveness; decision model; diagnostic test.
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