Sexually transmitted infections screening at HIV treatment centers for MSM can be cost-effective.
OBJECTIVE
To estimate the cost-effectiveness of anorectal chlamydia screening among men who have sex with men (MSM) in care at HIV treatment centers.


METHODS
Transmission model combined with economic analysis over a 20-year period.


METHODS
MSM in care at HIV treatment centers.


METHODS
Once-yearly or twice-yearly screening for anorectal chlamydia among MSM in care at HIV treatment centers.


METHODS
Averted HIV and chlamydia infections; discounted quality-adjusted life-years and costs; incremental cost-effectiveness ratio (ICER).


RESULTS
Costs will be saved by routine chlamydia screening of MSM in care at HIV treatment centers if these patients seek little or no screening elsewhere. Nonroutine screening is considerably more expensive than routine screening offered within a scheduled visit. Adding once-yearly chlamydia screening for MSM in care at HIV treatment centers is cost saving when 30% or fewer of those men seek once-yearly screening elsewhere (1.5 to 8.1 million euro saved). Twice-yearly routine screening at HIV treatment centers is cost-effective only when routine screening takes place without additional nonroutine screening (1.9 million euro saved).


CONCLUSIONS
Adding annual chlamydia screening to the HIV consultation will be cost saving as long as only a limited proportion of men are nonroutinely screened. The ICER was most sensitive to the percentage of MSM that continue to be screened elsewhere.
aCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven bDepartment of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam cDepartment of Dermatology, Academic Medical Center, Amsterdam dSTI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam eResearch Department, Cluster for Infectious Diseases, Public Health Service of Amsterdam, Amsterdam fInternal Medicine and Infectious Diseases, Erasmus University Medical Center, Rotterdam gUnit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen hJulius Center, University Medical Center, Utrecht, the Netherlands.
Henrike J
HJ
Vriend
Anna K
AK
Lugnér
Maria
M
Xiridou
Maarten F
MF
Schim van der Loeff
Maria
M
Prins
Henry J C
HJ
de Vries
Suzanne E
SE
Geerlings
Jan M
JM
Prins
Bart J A
BJ
Rijnders
Maaike G
MG
van Veen
Johannes S A
JS
Fennema
Maarten J
MJ
Postma
Marianne A B
MA
van der Sande
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D003362:Cost-Benefit Analysis; D005260:Female; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D055815:Young Adult