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Research

Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c7250 (Published 04 January 2011) Cite this as: BMJ 2011;342:c7250
  1. Katy Turner, NIHR research fellow1,
  2. Elisabeth Adams, health economics consultant2,
  3. Arabella Grant, health economics consultant3,
  4. John Macleod, professor of clinical epidemiology and primary care 1,
  5. Gill Bell, health adviser in genitourinary medicine4,
  6. Jan Clarke, consultant in genitourinary medicine5,
  7. Paddy Horner, Walport consultant senior lecturer16
  1. 1Bristol University, Department of Social Medicine, Bristol BS8 2PS, UK
  2. 2London, UK
  3. 3Pathway Analytics, London
  4. 4Sheffield Teaching Hospitals, NHS Foundation Trust, Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
  5. 5Department of Genitourinary Medicine, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK
  6. 6Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 0JD
  1. Correspondence to: K Turner katy.turner{at}bristol.ac.uk
  • Accepted 4 October 2010

Abstract

Objectives To compare the cost, cost effectiveness, and sex equity of different intervention strategies within the English National Chlamydia Screening Programme. To develop a tool for calculating cost effectiveness of chlamydia control programmes at a local, national, or international level.

Design An economic and mathematical modelling study with cost effectiveness analysis. Costs were restricted to those of screening and partner notification from the perspective of the NHS and excluded patient costs, the costs of reinfection, and costs of complications arising from initial infection.

Setting England.

Population Individuals eligible for the National Chlamydia Screening Programme.

Main outcome measures Cost effectiveness of National Chlamydia Screening Programme in 2008–9 (as cost per individual tested, cost per positive diagnosis, total cost of screening, number screened, number infected, sex ratio of those tested and treated). Comparison of baseline programme with two different interventions—(i) increased coverage of primary screening in men and (ii) increased efficacy of partner notification.

Results In 2008–9 screening was estimated to cost about £46.3m in total and £506 per infection treated. Provision for partner notification within the screening programme cost between £9 and £27 per index case, excluding treatment and testing. The model results suggest that increasing male screening coverage from 8% (baseline value) to 24% (to match female coverage) would cost an extra £22.9m and increase the cost per infection treated to £528. In contrast, increasing partner notification efficacy from 0.4 (baseline value) to 0.8 partners per index case would cost an extra £3.3m and would reduce the cost per infection diagnosed to £449. Increasing screening coverage to 24% in men would cost over six times as much as increasing partner notification to 0.8 but only treat twice as many additional infections.

Conclusions In the English National Chlamydia Screening Programme increasing the effectiveness of partner notification is likely to cost less than increasing male coverage but also improve the ratio of women to men diagnosed. Further evaluation of the cost effectiveness of partner notification and screening is urgently needed. The spreadsheet tool developed in this study can be easily modified for use in other settings to evaluate chlamydia control programmes.

Footnotes

  • We thank Johanna Riha, from the National Chlamydia Screening Programme (NCSP) team and Health Protection Agency, for providing data on the reported efficacy of partner notification for selected sites. We also thank Marie Kernec (Health Protection Agency) and Vikki Pearce, who worked on the NCSP costing guidance initiative.

  • Contributors: KT and PH conceived the initial idea for the paper. KT planned the analysis, designed the model, and planned and wrote the first draft of the paper. PH informed the model and planning of the study and contributed to writing and revising the paper. EA and AG provided the cost data for partner notification pathways, undertook the economic analysis, and advised on the model. JM advised during initial planning and input into model development. JC advised on the model, particularly in relation to NCSP data and management. GB advised on partner notification strategies and provided data on partner notification pathways and her experience of providing partner notification in practice. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis, and have critically revised the first draft and reviewed and approved the submitted and revised manuscripts

  • Funding: This work was supported by a grant from the Bristol Sexual Health Centre Capacity Building Research Fund. KT is supported by an NIHR PDF fellowship. KT and GB also received funding from the NIHR Health Technology Assessment programme (project number 07/42/02). All authors in this paper are independent of their funders for publication purposes. The views and opinions expressed here are those of the authors and do not necessarily reflect those of the funders.

  • Competing interests: JC, PH, and JM are board members of the National Chlamydia Screening Advisory Group of the Department of Health and receive expenses for travel to meetings. JC also receives compensation for secondment as chair on NCSAG paid directly to Leeds Hospital Teaching Hospitals Trust. AG and EA received consultancy fees from Bristol Sexual Health Centre Capacity Building Research Fund for the additional cost data analysis and travel to a meeting with the other authors. EA and AG did consultancy work for the NCSP in spring 2009 on a project to estimate the cost of chlamydia screening. KT received consultancy fees from Bristol Sexual Health Centre Capacity Building Research Fund for additional days worked to develop the model and write the paper outside funded time. KT and EA were previously employed by the Health Protection Agency to work on economic and mathematical models of the impact of chlamydia screening. PH collaborated in a multicentre evaluation of a new molecular diagnostic test for chlamydia and gonorrhoea by Siemens Healthcare Diagnostics, for which his department received funding.

  • Ethical approval: No approval was required for this study

  • Data sharing: The excel spreadsheet, user guide, and dataset are provided in the appendices on bmj.com and are available from the corresponding author (katy.turner@bristol.ac.uk).

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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