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What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the Prevention Of Pelvic Infection (POPI) trial
  1. Adamma Aghaizu1,
  2. Elisabeth J Adams2,
  3. Katy Turner3,
  4. Sally Kerry1,
  5. Phillip Hay4,
  6. Ian Simms5,
  7. Pippa Oakeshott1
  1. 1Population Health Sciences and Education, St George's University of London, London, UK
  2. 2Health Economics Consultant, London, UK
  3. 3Department of Community and Social Medicine, University of Bristol, Bristol, UK
  4. 4Department of Genitourinary Medicine, St George's Hospital, London, UK
  5. 5HIV and STI Department, Health Protection Agency, Centre for Infections, London, UK
  1. Correspondence to Adamma Aghaizu, St George's, University of London, London SW17 0RE, UK; aaghaizu{at}sgul.ac.uk

Abstract

Objectives To describe healthcare settings attended by women with clinical pelvic inflammatory disease (PID), to calculate the cost of a PID episode and to estimate how many cases could be prevented in London annually at current chlamydia screening levels.

Methods An ethnically diverse sample of 2259 16–24 year old, sexually active, female London students were recruited to a chlamydia screening trial in 2004–2006 of whom 94% (2115) were followed up after 12 months for incidence of PID. A cost analysis examined healthcare settings attended by women with PID, the cost of an episode of PID and the number of cases of PID in London due to untreated chlamydia at baseline that could be prevented per year at 2009 annual screening levels.

Results Of 35 PID cases, 17 (47%) first presented in general practice, 15 (42%) at a genitourinary medicine clinic, two elsewhere and one was admitted to hospital. The average number of consultations for a PID episode was 2.0 (range 1–4) and the average cost was £163 (range £29–960). Assuming 414 345 sexually active women aged 16–24 in London, 6% chlamydia prevalence at baseline and a 7.3% difference in PID rates between screened and unscreened chlamydia positives, 391 (95% CI −44 to 882) cases of chlamydia-associated PID costing £63 733 could be prevented each year in London at 21.5% 2009 annual screening levels.

Conclusions Most women with PID were managed in the community. The number and cost of PID cases prevented by a single annual chlamydia screen is low suggesting that cost effectiveness may depend mainly on the prevention of long-term sequelae.

  • Chlamydia trachomatis
  • screening

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Footnotes

  • Funding This study was supported by the BUPA Foundation (grant no 684/GB14B).

  • Competing interests None declared.

  • Ethics approval This study was approved by Wandsworth research ethics committee (reference 03.0012).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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