The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.
OBJECTIVE
The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.


METHODS
Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves.


RESULTS
The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94,717. For cost-effectiveness threshold values of €45,000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%.


CONCLUSIONS
An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.
School of Business and Economics, National University of Ireland Galway, Ireland. paddy.gillespie@nuigalway.ie
Paddy
P
Gillespie
Ciaran
C
O'Neill
Elisabeth
E
Adams
Katherine
K
Turner
Diarmuid
D
O'Donovan
Ruairi
R
Brugha
Deirdre
D
Vaughan
Emer
E
O'Connell
Martin
M
Cormican
Myles
M
Balfe
Claire
C
Coleman
Margaret
M
Fitzgerald
Catherine
C
Fleming
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D019411:Clinical Laboratory Techniques / Q000191:economics*; D003362:Cost-Benefit Analysis; D004823:Epididymitis / Q000517:prevention & control; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000517:prevention & control; D010865:Pilot Projects; D018410:Pneumonia, Bacterial / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011271:Pregnancy, Ectopic / Q000517:prevention & control; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D014141:Trachoma / Q000517:prevention & control; D055815:Young Adult