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The cost effectiveness of opportunistic chlamydia screening in England
  1. Elisabeth J Adams1,
  2. Katherine M E Turner2,
  3. W John Edmunds1
  1. 1Modelling & Economics Unit, Health Protection Agency, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
  2. 2Infectious Disease Epidemiology, Imperial College, St Mary’s Campus, Norfolk Place, London W2 1PG, UK
  1. Correspondence to:
 W J Edmunds
 Modelling & Economics Unit, Health Protection Agency, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK; john.edmunds{at}hpa.org.uk

Abstract

Background/aim: The National Chlamydia Screening Programme (NCSP) is being implemented in England. This study aims to estimate the cost effectiveness of (a) the NCSP strategy (annual screening offer to men and women aged under 25 years) and (b) alternative screening strategies.

Methods: A stochastic, individual based, dynamic sexual network model was combined with a cost effectiveness model to estimate the complications and associated costs of chlamydial infection. The model was constructed and parameterised from the perspective of the National Health Service (NHS) (England), including the direct costs of infection, complications and screening. Unit costs were derived from standard data sources and published studies. The average and incremental cost effectiveness ratio (cost per major outcome averted or quality adjusted life year (QALY) gained) of chlamydia screening strategies targeting women and/or men of different age groups was estimated. Sensitivity analyses were done to explore model uncertainty.

Results: All screening strategies modelled are likely to cost the NHS money and improve health. If pelvic inflammatory disease (PID) progression is less than 10% then screening at any level is unlikely to be cost effective. However, if PID progression is 10% or higher the NCSP strategy compared to no screening appears to be cost effective. The incremental cost effectiveness analysis suggests that screening men and women aged under 20 years is the most beneficial strategy that falls below accepted thresholds. There is a high degree of uncertainty in the findings.

Conclusions: Offering an annual screening test to men and women aged under 20 years may be the most cost effective strategy (that is, under accepted thresholds) if PID progression is 10% or higher.

  • CER, cost effectiveness ratio
  • EP, ectopic pregnancy
  • ICER, incremental cost effectiveness ratio
  • MO, major outcome
  • MOA, major outcomes averted
  • NCSP, National Chlamydia Screening Programme
  • PID, pelvic inflammatory disease
  • PN, partner notification
  • QALY, quality adjusted life year
  • TFI, tubal factor infertility
  • Chlamydia trachomatis
  • screening
  • cost effectiveness
  • mathematical model
  • health economics
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Footnotes

  • Published Online First 2 April 2007

  • Funding: Funding for the work was provided by the Health Protection Agency and the Department of Health (England).

  • Conflict of interest: none.

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