The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland
- Paddy Gillespie1,
- Ciaran O'Neill1,
- Elisabeth Adams2,
- Katherine Turner3,
- Diarmuid O'Donovan1,4,
- Ruairi Brugha5,
- Deirdre Vaughan1,
- Emer O'Connell6,
- Martin Cormican1,7,
- Myles Balfe5,
- Claire Coleman7,
- Margaret Fitzgerald8,
- Catherine Fleming1
- 1National University of Ireland Galway, Ireland
- 2Health Economics Consultant, London, UK
- 3University of Bristol, UK
- 4Health Service Executive West, Ireland
- 5Royal College of Surgeons Dublin, Ireland
- 6Health Service Executive Dublin/Mid-Leinster, Ireland
- 7University Hospital Galway, Ireland
- 8Health Service Executive Dublin, Ireland
- Correspondence to Dr Paddy Gillespie, School of Business and Economics, National University of Ireland Galway, Ireland;
Contributors DOD, RB, EOC, DV, MC, CF, CC, MF and MB designed the study, developed and piloted the screening strategy and undertook the data collection process. EA and KT undertook the dynamic modelling analyses. PG and CON undertook the economic analysis and drafted the initial version of the manuscript. All authors participated in the revision of the manuscript and have agreed upon the final version.
- Accepted 4 December 2011
- Published Online First 2 January 2012
Objective The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.
Methods Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves.
Results The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94 717. For cost-effectiveness threshold values of €45 000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%.
Conclusions An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.
- economic analysis
- health service research
- chlamydia infection
- mathematical model
- genitourinary medicine services
- hepatitis B
- natural history
- antibiotic resistance
- sexual behaviour
- STD control
- Chlamydia trachomatis
Funding The research was funded by the Health Protection Surveillance Centre and Health Research Board in Ireland. The study sponsors had no part in the design of the study; the collection, analysis and interpretation of the data; the writing of the report and the decision to submit the article for publication.
Competing interests None.
Ethics approval The pilot study was approved by the ethics committee of the National University of Ireland Galway and by the ethics committee of the Irish College of General Practitioners.
Provenance and peer review Not commissioned; externally peer reviewed.