Partner notification to prevent pelvic inflammatory disease in women. Cost-effectiveness of two strategies.

BACKGROUND AND OBJECTIVES Partner notification is an important strategy for prevention of Chlamydia trachomatis infection and pelvic inflammatory disease (PID). PID can be prevented by early diagnosis and treatment of the female sex partners of men infected with C. trachomatis (strategy 1) and by preventing reinfection in women through diagnosis and treatment of their male sex partners (strategy 2). STUDY DESIGN Using a decision model, the cost-effectiveness of strategies 1 and 2 was compared to no partner notification. Outcomes were measured by cases of PID prevented and net costs expended from a health care system perspective. RESULTS In a hypothetical cohort of 1,000 male and 1,000 female index patients, strategy 1 prevented 64 and strategy 2 prevented 20 cases of PID. Strategy 1 saved $247,000 and strategy 2 saved $33,000 over no partner notification. Sensitivity analysis showed that strategy 1 was cost-effective across a wide range of assumptions. Strategy 2 was cost-effective at baseline, but its cost-saving ability was subject to changes in the model. CONCLUSION Partner notification of both male and female index patients is a cost-effective public health strategy for prevention of PID. In most settings, both strategies can and should be implemented.