Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project.
OBJECTIVE
To investigate the cost effectiveness of screening for Chlamydia trachomatis compared with a policy of no organised screening in the United Kingdom.


METHODS
Economic evaluation using a transmission dynamic mathematical model.


METHODS
Central and southwest England.


METHODS
Hypothetical population of 50,000 men and women, in which all those aged 16-24 years were invited to be screened each year.


METHODS
Cost effectiveness based on major outcomes averted, defined as pelvic inflammatory disease, ectopic pregnancy, infertility, or neonatal complications.


RESULTS
The incremental cost per major outcome averted for a programme of screening women only (assuming eight years of screening) was 22,300 pounds (33,000 euros; $45,000) compared with no organised screening. For a programme screening both men and women, the incremental cost effectiveness ratio was approximately 28,900 pounds. Pelvic inflammatory disease leading to hospital admission was the most frequently averted major outcome. The model was highly sensitive to the incidence of major outcomes and to uptake of screening. When both were increased the cost effectiveness ratio fell to 6200 pound per major outcome averted for screening women only.


CONCLUSIONS
Proactive register based screening for chlamydia is not cost effective if the uptake of screening and incidence of complications are based on contemporary empirical studies, which show lower rates than commonly assumed. These data are relevant to discussions about the cost effectiveness of the opportunistic model of chlamydia screening being introduced in England.
Health Economics Facility, HSMC, University of Birmingham, Birmingham, Switzerland. T.E.Roberts@bham.ac.uk
Tracy E
TE
Roberts
Suzanne
S
Robinson
Pelham M
PM
Barton
Stirling
S
Bryan
Anne
A
McCarthy
John
J
Macleod
Matthias
M
Egger
Nicola
N
Low
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D002692:Chlamydia trachomatis; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007246:Infertility / Q000382:microbiology; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D000292:Pelvic Inflammatory Disease / Q000382:microbiology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000382:microbiology; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome