TY - JOUR
T1 - Chlamydia screening is not cost-effective at low participation rates
T2 - Evidence from a repeated register-based implementation study in the Netherlands
AU - De Wit, G.A.
AU - Over, E.A.B.
AU - Schmid, B.V.
AU - Van Bergen, J.E.A.M.
AU - Van Den Broek, I.V.F.
AU - Van Der Sande, M.A.B.
AU - Welte, R.
AU - Op De Coul, E.L.M.
AU - Kretzschmar, M.E.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - 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.
AB - 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.
U2 - 10.1136/sextrans-2014-051677
DO - 10.1136/sextrans-2014-051677
M3 - Article
SN - 1368-4973
VL - 91
SP - 423
EP - 429
JO - Sexually Transmitted Infections
JF - Sexually Transmitted Infections
IS - 6
ER -