Læknablaðið

Ukioqatigiit

Læknablaðið - 15.08.1995, Qupperneq 41

Læknablaðið - 15.08.1995, Qupperneq 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 15^4) 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-benefícial 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-b. 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 Intemational Society for STD Research. Sex Transm Dis 1994; 21/Suppl. 2: 1-219.
Qupperneq 1
Qupperneq 2
Qupperneq 3
Qupperneq 4
Qupperneq 5
Qupperneq 6
Qupperneq 7
Qupperneq 8
Qupperneq 9
Qupperneq 10
Qupperneq 11
Qupperneq 12
Qupperneq 13
Qupperneq 14
Qupperneq 15
Qupperneq 16
Qupperneq 17
Qupperneq 18
Qupperneq 19
Qupperneq 20
Qupperneq 21
Qupperneq 22
Qupperneq 23
Qupperneq 24
Qupperneq 25
Qupperneq 26
Qupperneq 27
Qupperneq 28
Qupperneq 29
Qupperneq 30
Qupperneq 31
Qupperneq 32
Qupperneq 33
Qupperneq 34
Qupperneq 35
Qupperneq 36
Qupperneq 37
Qupperneq 38
Qupperneq 39
Qupperneq 40
Qupperneq 41
Qupperneq 42
Qupperneq 43
Qupperneq 44
Qupperneq 45
Qupperneq 46
Qupperneq 47
Qupperneq 48
Qupperneq 49
Qupperneq 50
Qupperneq 51
Qupperneq 52
Qupperneq 53
Qupperneq 54
Qupperneq 55
Qupperneq 56
Qupperneq 57
Qupperneq 58
Qupperneq 59
Qupperneq 60
Qupperneq 61
Qupperneq 62
Qupperneq 63
Qupperneq 64
Qupperneq 65
Qupperneq 66
Qupperneq 67
Qupperneq 68

x

Læknablaðið

Direct Links

Hvis du vil linke til denne avis/magasin, skal du bruge disse links:

Link til denne avis/magasin: Læknablaðið
https://timarit.is/publication/986

Link til dette eksemplar:

Link til denne side:

Link til denne artikel:

Venligst ikke link direkte til billeder eller PDfs på Timarit.is, da sådanne webadresser kan ændres uden advarsel. Brug venligst de angivne webadresser for at linke til sitet.