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Assessing the costs and outcomes of control programmes for sexually transmitted infections: a systematic review of economic evaluations
  1. Sonja C M Bloch1,
  2. Louise J Jackson1,
  3. Emma Frew1,
  4. Jonathan D C Ross2
  1. 1 Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2 Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Sonja C M Bloch, Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; s.bloch{at}


Objective To identify economic evaluations of interventions to control STIs and HIV targeting young people, and to assess how costs and outcomes are measured in these studies.

Design Systematic review.

Data sources Seven databases were searched (Medline (Ovid), EMBASE (Ovid), Web of Science, PsycINFO, NHS Economic Evaluation Database, NHS Health Technology Assessment and Database of Abstracts of Reviews of Effects) from January 1999 to April 2019. Key search terms were STIs (chlamydia, gonorrhoea, syphilis) and HIV, cost benefit, cost utility, economic evaluation, public health, screening, testing and control.

Review methods Studies were included that measured costs and outcomes to inform an economic evaluation of any programme to control STIs and HIV targeting individuals predominantly below 30 years of age at risk of, or affected by, one or multiple STIs and/or HIV in Organisation for Economic Co-operation and Development countries. Data were extracted and tabulated and included study results and characteristics of economic evaluations. Study quality was assessed using the Philips and BMJ checklists. Results were synthesised narratively.

Results 9530 records were screened and categorised. Of these, 31 were included for data extraction and critical appraisal. The majority of studies assessed the cost-effectiveness or cost-utility of screening interventions for chlamydia from a provider perspective. The main outcome measures were major outcomes averted and quality-adjusted life years. Studies evaluated direct medical costs, for example, programme costs and 11 included indirect costs, such as productivity losses. The study designs were predominantly model-based with significant heterogeneity between the models.

Discussion/Conclusion None of the economic evaluations encompassed aspects of equity or context, which are highly relevant to sexual health decision-makers. The review demonstrated heterogeneity in approaches to evaluate costs and outcomes for STI/HIV control programmes. The low quality of available studies along with the limited focus, that is, almost all studies relate to chlamydia, highlight the need for high-quality economic evaluations to inform the commissioning of sexual health services.

  • economics
  • medical
  • diagnostic screening programs
  • sexual health
  • infection control
  • HIV

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  • Handling editor Jason J Ong

  • Twitter @SCMBloch

  • Contributors SCMB undertook the main analysis and prepared the initial manuscript. All other authors (LJJ, JR, EF) contributed to the analysis and the development of the manuscript. All authors approved the final version. LJJ is the guarantor of this review.

  • Funding This research was part of the corresponding author’s PhD research, which was funded by Umbrella Sexual Health Services, University Hospital Birmingham NHS Foundation Trust.

  • Disclaimer The funder played no role in the design of the study, nor the analysis of the data, nor in the preparation of the manuscript.

  • Competing interests None declared.

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