Optimizing strategies for population-based chlamydia infection screening among young women: An age-structured system dynamics approach

Yu Teng, Nan Kong, Wanzhu Tu

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Chlamydia infection (CT) is one of the most commonly reported sexually transmitted diseases. It is often referred to as a "silent" disease with the majority of infected people having no symptoms. Without early detection, it can progress to serious reproductive and other health problems. Economical identification of asymptomatically infected is a key public health challenge. Increasing evidence suggests that CT infection risk varies over the range of adolescence. Hence, age-dependent screening strategies with more frequent testing for certain age groups of higher risk may be cost-saving in controlling the disease. Methods: We study the optimization of age-dependent screening strategies for population-based chlamydia infection screening among young women. We develop an age-structured compartment model for CT natural progress, screening, and treatment. We apply parameter optimization on the resultant PDE-based system dynamical models with the objective of minimizing the total care spending, including screening and treatment costs during the program period and anticipated costs of treating the sequelae afterwards). For ease of practical implementation, we also search for the best screening initiation age for strategies with a constant screening frequency. Results: The optimal age-dependent strategies identified outperform the current CDC recommendations both in terms of total care spending and disease prevalence at the termination of the program. For example, the age-dependent strategy that allows monthly screening rate changes can save about 5 % of the total spending. Our results suggest early initiation of CT screening is likely beneficial to the cost saving and prevalence reduction. Finally, our results imply that the strategy design may not be sensitive to accurate quantification of the age-specific CT infection risk if screening initiation age and screening rate are the only decisions to make. Conclusions: Our research demonstrates the potential economic benefit of age-dependent screening strategy design for population-based screening programs. It also showcases the applicability of age-structured system dynamical modeling to infectious disease control with increasing evidence on the age differences in infection risk. The research can be further improved with consideration of the difference between first-time infection and reinfection, as well as population heterogeneity in sexual partnership.

Original languageEnglish (US)
Article number639
JournalBMC Public Health
Volume15
Issue number1
DOIs
StatePublished - Dec 12 2015

Fingerprint

Chlamydia Infections
Infection
Costs and Cost Analysis
Population
Reproductive Health
Population Characteristics
Centers for Disease Control and Prevention (U.S.)
Sexually Transmitted Diseases
Research
Health Care Costs
Communicable Diseases
Public Health
Age Groups
Economics
Therapeutics

Keywords

  • Age-structured system dynamics
  • Disease screening
  • Infectious disease modeling
  • Parameter optimization

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Optimizing strategies for population-based chlamydia infection screening among young women : An age-structured system dynamics approach. / Teng, Yu; Kong, Nan; Tu, Wanzhu.

In: BMC Public Health, Vol. 15, No. 1, 639, 12.12.2015.

Research output: Contribution to journalArticle

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abstract = "Background: Chlamydia infection (CT) is one of the most commonly reported sexually transmitted diseases. It is often referred to as a {"}silent{"} disease with the majority of infected people having no symptoms. Without early detection, it can progress to serious reproductive and other health problems. Economical identification of asymptomatically infected is a key public health challenge. Increasing evidence suggests that CT infection risk varies over the range of adolescence. Hence, age-dependent screening strategies with more frequent testing for certain age groups of higher risk may be cost-saving in controlling the disease. Methods: We study the optimization of age-dependent screening strategies for population-based chlamydia infection screening among young women. We develop an age-structured compartment model for CT natural progress, screening, and treatment. We apply parameter optimization on the resultant PDE-based system dynamical models with the objective of minimizing the total care spending, including screening and treatment costs during the program period and anticipated costs of treating the sequelae afterwards). For ease of practical implementation, we also search for the best screening initiation age for strategies with a constant screening frequency. Results: The optimal age-dependent strategies identified outperform the current CDC recommendations both in terms of total care spending and disease prevalence at the termination of the program. For example, the age-dependent strategy that allows monthly screening rate changes can save about 5 {\%} of the total spending. Our results suggest early initiation of CT screening is likely beneficial to the cost saving and prevalence reduction. Finally, our results imply that the strategy design may not be sensitive to accurate quantification of the age-specific CT infection risk if screening initiation age and screening rate are the only decisions to make. Conclusions: Our research demonstrates the potential economic benefit of age-dependent screening strategy design for population-based screening programs. It also showcases the applicability of age-structured system dynamical modeling to infectious disease control with increasing evidence on the age differences in infection risk. The research can be further improved with consideration of the difference between first-time infection and reinfection, as well as population heterogeneity in sexual partnership.",
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