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Chlamydia sequelae cost estimates used in current economic evaluations: does one-size-fit-all?
  1. Koh Jun Ong1,
  2. Kate Soldan2,
  3. Mark Jit2,3,
  4. J Kevin Dunbar1,
  5. Sarah C Woodhall1
  1. 1HIV/STI Department, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
  2. 2Modelling and Economics Unit, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Koh Jun Ong, HIV/STI Department, Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;{at}


Background Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark).

Methods From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values.

Results Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412.

Conclusions There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.


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  • Handling editor Jackie A Cassell

  • Contributors KJO designed the analysis, developed the methodology, collected the data, performed the analysis and wrote the manuscript. KS designed the analysis and commented on the methodology and manuscript. MJ commented on the methodology and manuscript. JKD commented on the manuscript. SCW commented on the methodology, the analysis and the manuscript.

  • Competing interests None declared.

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