A recent systematic review of economic evaluations suggests that screening for genital chlamydia infection is “cost effective.”¹ We are concerned about how the authors reached this conclusion since the reviewers did not take into account the fact that Chlamydia trachomatis is infectious. The methodological problems arising from this fundamental flaw raise questions about the validity of the conclusion.

The correct model to use in the evaluation of an infectious disease must be capable of encompassing all its effects, including the potential for transmission. Bernoulli first reported such transmission dynamic models in the 18th century.² The wide misuse of static, as opposed to transmission dynamic, models has been noted …