title: An economic model of school-based behavioral interventions to prevent sexually transmitted infections.
abstract: OBJECTIVE
  Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people.
  
  
  METHODS
  We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs.
  
  
  RESULTS
  The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.
  
  
  CONCLUSIONS
  School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.
authors.affiliation: Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK. kc@soton.ac.uk
authors.forename: Keith
authors.initials: K
authors.lastname: Cooper
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shepherd
authors.forename: Jo
authors.initials: J
authors.lastname: Picot
authors.forename: Jeremy
authors.initials: J
authors.lastname: Jones
authors.forename: Josephine
authors.initials: J
authors.lastname: Kavanagh
authors.forename: Angela
authors.initials: A
authors.lastname: Harden
authors.forename: Elaine
authors.initials: E
authors.lastname: Barnett-Page
authors.forename: Andrew
authors.initials: A
authors.lastname: Clegg
authors.forename: Debbie
authors.initials: D
authors.lastname: Hartwell
authors.forename: Geoff
authors.initials: G
authors.lastname: Frampton
authors.forename: Alison
authors.initials: A
authors.lastname: Price
mesh_terms: D000293:Adolescent; D003362:Cost-Benefit Analysis; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006801:Humans; D008019:Life Style; D008297:Male; D018803:Models, Economic; D010379:Peer Group; D011247:Pregnancy; D011634:Public Health; D011788:Quality of Life; D012309:Risk-Taking; D012572:School Health Services / Q000191:economics*; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology