Læknablaðið - 15.08.1995, Blaðsíða 41

Læknablaðið - 15.08.1995, Blaðsíða 41
LÆKNABLAÐIÐ 1995; 81 617 women will develop clinical PID. Of the re- maining (9600) women at least 60% (5800) will develop subclinical PID. This figure is based on the prevalence of plasma cell endometritis detected by endometrial biopsies in asympto- matic women with Chlamydial cervicitis. Fur- thermore, seroepidemiological studies suggest that only one fifth of women with tubal factor infertility have a history of a Chlamydial in- fection or PID. Hence, both these observa- tions suggest that a great proportion of PID is asymptomatic and that a great proportion of tubal damage is associated with asymptomatic Chlamydial infection. Of the 8200 PID pa- tients approximately 3000 will develop tubal infertility and approximately 3000 will develop mild tubal damage increasing the risk of tubal pregnancy. Seventeen percent of all couples in Finland suffer from involuntary infertility, and approximately 25% of infertile women have tubal factor infertility. Based on seroepidemi- ological studies, two thirds of these are caused by the sequelae of past Chlamydial infection. In such infertility cases in vitro fertilization (IVF) is the only effective treatment. The cost of one IVF treatment is approximately 10,500 FIM, and the success rate varies from 20-35% (up to three IVF attempts per patient) depend- ing on the age group. In the Helsinki metropol- itan area (population approximately one mil- lion) at least 400 IVF treatments are perform- ed per month, representing some 5000 IVF treatments annually. The incidence of tubal pregnancies in Fin- land (175/100,000 in the age group of 15^14) is higher than in other developed countries. Ap- proximately one half of tubal pregnancies are associated with past Chlamydial infection. The cost for treatment and diagnosis of one tubal pregnancy, using operative laparoscopy is ap- proximately 8500 FIM. Thus, a very conserva- tive estimate is that the direct annual costs caused by the sequelae to Chlamydial infec- tions in Finland are at least 129 million FIM (table IV). Secondary prevention of Chlamydial infections is cost-beneficial Primary prevention means education (schools, media etc.) and counselling in order to minimize exposure to and acquisition of C. trachomatis. Secondary prevention means more sensitive diagnostics (for instance PCR), risk assessment, and screening of high risk groups (antenatal clinics, adolescent clinics, army recruits, family planning clinics, etc). It is also important to include in secondary pre- vention the four Cs, i.e. condom use, counsel- ling, compliance and contact tracing. It has been estimated that if Chlamydial in- fections could be prevented tubal factor in- fertility would decline by at least 80%, and tubal pregnancies by at least 50%. Some cases of reactive arthritis, premature delivery, neo- natal infections and postpartum infections could also be prevented. Chlamydial screening during pregnancy is important in order to pre- vent pregnancy complications, postpartum in- fections and perinatal morbidity. Recent stud- ies suggest that approximately 3% of pregnant women in Finland have Chlamydial infection. However, Chlamydia screening programs in the antenatal clinics do not exist. Table III shows theoretical cost estimate of universal Chlamydia screening program an- nually in Finland. The cost of screening is only one fifth of the total costs caused by undiag- nosed Chlamydial infections. Efficient risk as- sessment can further reduce the cost of screen- ing programs by targeting screening to the high risk groups. Studies have shown that screening can be targeted so that when the total pop- ulation screened is reduced by half only 10% of Chlamydia positive cases are missed. In sum- mary, the cost of screening is only a fraction of costs created by the well-known sequelae of undiagnosed Chlamydial infections. Thus, the key message is that allocating less resources to screening programs will evidently create major costs to the health care system in the future. REFERENCES Márdh P-A, Paavonen J, Puolakkainen M. Chlamydia. Plen- um Publishing Corporation, 1989. Chlamydial Infections. Proceedings of the 8th International Symposium on Human Chlamydial Infection, June 19-24, 1994, Chateau de Montvillargenne, France. J Orfila, et al eds. Bolognia: Societa Editrise, Esculapio. Robinson R. Cost-benefit analysis. Br Med J 1993; 307: 924-6. Robinson R. Cost-effectiveness analysis. Br Med J 1993; 307: 793-5. Robinson R. Cost-utility analysis. Br Med J 1993; 307: 859- 62. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology a Basic Science for Clinical Medicine. Little, Brown and Company, 1985 Proceedings of the International Society for STD Research. Sex Transm Dis 1994; 21/Suppl. 2: 1-219.
Blaðsíða 1
Blaðsíða 2
Blaðsíða 3
Blaðsíða 4
Blaðsíða 5
Blaðsíða 6
Blaðsíða 7
Blaðsíða 8
Blaðsíða 9
Blaðsíða 10
Blaðsíða 11
Blaðsíða 12
Blaðsíða 13
Blaðsíða 14
Blaðsíða 15
Blaðsíða 16
Blaðsíða 17
Blaðsíða 18
Blaðsíða 19
Blaðsíða 20
Blaðsíða 21
Blaðsíða 22
Blaðsíða 23
Blaðsíða 24
Blaðsíða 25
Blaðsíða 26
Blaðsíða 27
Blaðsíða 28
Blaðsíða 29
Blaðsíða 30
Blaðsíða 31
Blaðsíða 32
Blaðsíða 33
Blaðsíða 34
Blaðsíða 35
Blaðsíða 36
Blaðsíða 37
Blaðsíða 38
Blaðsíða 39
Blaðsíða 40
Blaðsíða 41
Blaðsíða 42
Blaðsíða 43
Blaðsíða 44
Blaðsíða 45
Blaðsíða 46
Blaðsíða 47
Blaðsíða 48
Blaðsíða 49
Blaðsíða 50
Blaðsíða 51
Blaðsíða 52
Blaðsíða 53
Blaðsíða 54
Blaðsíða 55
Blaðsíða 56
Blaðsíða 57
Blaðsíða 58
Blaðsíða 59
Blaðsíða 60
Blaðsíða 61
Blaðsíða 62
Blaðsíða 63
Blaðsíða 64
Blaðsíða 65
Blaðsíða 66
Blaðsíða 67
Blaðsíða 68



Beinir tenglar

Ef þú vilt tengja á þennan titil, vinsamlegast notaðu þessa tengla:

Tengja á þennan titil: Læknablaðið

Tengja á þetta tölublað:

Tengja á þessa síðu:

Tengja á þessa grein:

Vinsamlegast ekki tengja beint á myndir eða PDF skjöl á Tímarit.is þar sem slíkar slóðir geta breyst án fyrirvara. Notið slóðirnar hér fyrir ofan til að tengja á vefinn.