Background Chlamydia trachomatis (CT) is the most common notifiable infectious disease in Canada. Rates of infection have been increasing since the mid-1990s, suggesting that alternate control strategies may be required. Given that the current cost of Chlamydia infections in Canada is unknown, we sought to estimate the burden of CT in the Canadian population, to provide a foundation on which health economic analyses of competing Chlamydia control strategies can be constructed.
Methods We used an age- and sex-structured mathematical model parameterised to reproduce trends in CT prevalence in the Canadian population aged 10 to 39 years. Model parameters were derived from epidemiologic studies and by model calibration. We incorporated data on changing test patterns of asymptomatically infected individuals over time. Costs were identified, measured, and valued using a modified societal perspective and were converted to 2009 Canadian dollars. The main outcome measures were the current net cost and burden of illness attributable to CT infection.
Results The model reproduced trends in CT prevalence observed for the time period between 1991 and 2008. Under base case model assumptions, there appeared to be a trend of increasing detection of CT cases (due to increases in screening and subsequent detection of asymptomatic cases), despite an underlying decrease in actual CT infections in the population. The total estimated costs associated with CT infection over this time period were over $1.0 billion, or $56.4 million per year. The costs of screening and treatment of asymptomatic infections as a proportion of total CT costs were estimated to have increased over time, while the costs of long-term sequelae associated with untreated infections declined the same period.
Conclusions Despite increases in screening over time, the total economic burden associated with CT in Canada remains high; however, the projections of our model suggest that these increases in screening and the subsequent detection of asymptomatic infections may be reducing the costs associated with the treatment downstream sequelae of untreated infections. Further investigation of trends in chlamydia-associated complications is required to better understand the impact of screening on CT incidence in Canada.
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