title: Chlamydia screening is not cost-effective at low participation rates: evidence from a repeated register-based implementation study in The Netherlands.
abstract: OBJECTIVE
  In three pilot regions of The Netherlands, all 16-29 year olds were invited to participate in three annual rounds of Chlamydia screening. The aim of the present study is to evaluate the cost-effectiveness of repeated Chlamydia screening, based on empirical data.
  
  
  METHODS
  A mathematical model was employed to estimate the influence of repeated screening on prevalence and incidence of Chlamydial infection. A model simulating the natural history of Chlamydia was combined with cost and utility data to estimate the number of major outcomes and quality-adjusted life-years (QALYs) associated with Chlamydia. Six screening scenarios (16-29 years annually; 16-24 years annually; women only; biennial screening; biennial screening women only; screening every five years) were compared with no screening in two sexual networks, representing both lower ('national network') and higher ('urban network') baseline prevalence. Incremental cost-effectiveness ratios (ICERs) for the different screening scenarios were estimated. Uncertainty and sensitivity analyses were performed.
  
  
  RESULTS
  In all scenarios and networks, cost per major outcome averted are above €5000. Cost per QALY are at least €50,000. The default scenario as piloted in the Netherlands was least cost-effective, with ICERs of €232,000 in the national and €145,000 in the urban sexual network. Results were robust in sensitivity analyses.
  
  
  CONCLUSIONS
  It is unlikely that repeated rounds of Chlamydia screening will be cost-effective. Only at high levels of willingness to pay for a QALY (>€50,000) screening may be more cost-effective than no screening.
authors.affiliation: Prevention and Health Services, National Institute of Public Health and the Environment, Centre for Nutrition, Prevention and Health Services (VPZ), Bilthoven, the Netherlands Julius Center for Health Sciences and Primary Healthcare, University Medical Center, Utrecht, the Netherlands.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: Prevention and Health Services, National Institute of Public Health and the Environment, Centre for Nutrition, Prevention and Health Services (VPZ), Bilthoven, the Netherlands.
authors.forename: Eelco A B
authors.initials: EA
authors.lastname: Over
authors.affiliation: National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway.
authors.forename: Boris V
authors.initials: BV
authors.lastname: Schmid
authors.affiliation: National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands STI AIDS Netherlands, Amsterdam, the Netherlands Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jan E A M
authors.initials: JE
authors.lastname: van Bergen
authors.affiliation: National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
authors.forename: Ingrid V F
authors.initials: IV
authors.lastname: van den Broek
authors.affiliation: Julius Center for Health Sciences and Primary Healthcare, University Medical Center, Utrecht, the Netherlands National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Welte
authors.affiliation: National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
authors.forename: Eline L M
authors.initials: EL
authors.lastname: Op de Coul
authors.affiliation: Julius Center for Health Sciences and Primary Healthcare, University Medical Center, Utrecht, the Netherlands National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: Kretzschmar
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008962:Models, Theoretical; D009426:Netherlands / Q000453:epidemiology; D010358:Patient Participation / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012042:Registries
keywords: CHLAMYDIA TRACHOMATIS; COST-EFFECTIVENESS; MATHEMATICAL MODEL; SCREENING