Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project

doi:10.1136/bmj.39262.683345.AE

BMJ 2007;335:291 (11 August), doi:10.1136/bmj.39262.683345.AE (published 26 July 2007)

Research

Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project

Tracy E Roberts, senior lecturer in health economics¹, Suzanne Robinson, lecturer in health economics¹, Pelham M Barton, lecturer in mathematical modelling¹, Stirling Bryan, professor of health economics¹, Anne McCarthy, project manager², John Macleod, senior lecturer in primary care³, Matthias Egger, professor of epidemiology and public health⁴, Nicola Low, reader in epidemiology and public health⁴

¹ Health Economics Facility, HSMC, University of Birmingham, Birmingham B15 2RT, ² Department of Community Based Medicine, University of Bristol, Bristol BS6 6JL, ³ Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, ⁴ Department of Social and Preventive Medicine, University of Berne, Berne, CH-3012, Switzerland

Correspondence to: T E Roberts T.E.Roberts{at}bham.ac.uk

Objective To investigate the cost effectiveness of screeningfor Chlamydia trachomatis compared with a policy of no organisedscreening in the United Kingdom.

Design Economic evaluation using a transmission dynamic mathematicalmodel.

Setting Central and southwest England.

Participants Hypothetical population of 50 000 men and women,in which all those aged 16-24 years were invited to be screenedeach year.

Main outcome measures Cost effectiveness based on major outcomesaverted, defined as pelvic inflammatory disease, ectopic pregnancy,infertility, or neonatal complications.

Results The incremental cost per major outcome averted for aprogramme of screening women only (assuming eight years of screening)was £22 300 ( ${euro}$ 33 000; $45 000) compared with no organisedscreening. For a programme screening both men and women, theincremental cost effectiveness ratio was approximately £28900. Pelvic inflammatory disease leading to hospital admissionwas the most frequently averted major outcome. The model washighly sensitive to the incidence of major outcomes and to uptakeof screening. When both were increased the cost effectivenessratio fell to £6200 per major outcome averted for screeningwomen only.

Conclusions Proactive register based screening for chlamydiais not cost effective if the uptake of screening and incidenceof complications are based on contemporary empirical studies,which show lower rates than commonly assumed. These data arerelevant to discussions about the cost effectiveness of theopportunistic model of chlamydia screening being introducedin England.

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