Sexually transmitted infections screening at HIV treatment centers for MSM can be cost-effective

Objective: To estimate the cost-effectiveness of anorectal chlamydia screening among men who have sex with men (MSM) in care at HIV treatment centers. Design: Transmission model combined with economic analysis over a 20-year period. Setting and participants: MSM in care at HIV treatment centers. Intervention: Once-yearly or twice-yearly screening for anorectal chlamydia among MSM in care at HIV treatment centers. Main outcome measures: Averted HIV and chlamydia infections; discounted qualityadjusted life-years and costs; incremental cost-effectiveness ratio (ICER). Results: Costs will be saved by routine chlamydia screening of MSM in care at HIV treatment centers if these patients seek little or no screening elsewhere. Nonroutine screening is considerably more expensive than routine screening offered within a scheduled visit. Adding once-yearly chlamydia screening for MSM in care at HIV treatment centers is cost saving when 30% or fewer of those men seek once-yearly screening elsewhere (€1.5 to €8.1 million saved). Twice-yearly routine screening at HIV treatment centers is cost-effective only when routine screening takes place without additional nonroutine screening (€1.9 million saved). Conclusions: Adding annual chlamydia screening to the HIV consultation will be cost saving as long as only a limited proportion of men are nonroutinely screened. The ICER was most sensitive to the percentage of MSM that continue to be screened elsewhere.

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