10.25419/rcsi.10776749.v1
Myles Balfe
Myles
Balfe
Ruairi Brugha
Ruairi
Brugha
Emer O'Connell
Emer
O'Connell
Deirdre Vaughan
Deirdre
Vaughan
Claire Coleman
Claire
Coleman
Ronán Conroy
Ronán
Conroy
Martin Cormican
Martin
Cormican
Margaret Fitzgerald
Margaret
Fitzgerald
Catherine Fleming
Catherine
Fleming
Hannah McGee
Hannah
McGee
Andrew Murphy
Andrew
Murphy
Grainne Ni Fhoghlu
Grainne Ni
Fhoghlu
Ciaran O'Neill
Ciaran
O'Neill
Paddy Gillespie
Paddy
Gillespie
Chlamydia Screening in Ireland: a pilot study of opportunistic screening for genital Chlamydia trachomatis infection in Ireland (2007-2009). Economic evaluation
Royal College of Surgeons in Ireland
2019
Chlamydia
Screening
Ireland
Epidemiology
2019-11-22 15:53:58
Report
https://repository.rcsi.com/articles/report/Chlamydia_Screening_in_Ireland_a_pilot_study_of_opportunistic_screening_for_genital_Chlamydia_trachomatis_infection_in_Ireland_2007-2009_Economic_evaluation/10776749
<p><strong>Economic Evaluation</strong></p>
<p>The aim of the economic evaluation was to examine the cost effectiveness of the two screening models tested in the Chlamydia Screening in Ireland Pilot (CSIP) study: (a) Clinical Setting screening, and (b) ’Pee-in-a-pot’ periodic screening in third level institution/college settings. The methodological approach comprised of a dynamic transmission model paired with an economic model. In both analyses, screening was compared to a control strategy of no organised screening, that is existing care in Ireland.</p>
<p>A public health system or provider perspective was adopted with respect to costs. The analysis considered the cost of screening to the health service, and the costs of infection and complications, not any additional costs reported by young people in accepting a chlamydia screening test. Health outcomes were assessed in terms of major outcomes (MOs) averted and quality adjusted life years (QALYs) gained.</p>
<p>The costs of Clinical Setting screening were presented in terms of the <em>cost per offer </em>(€26 ), the <em>cost per negative case </em>(€66), the <em>cost per positive case </em>(€152), and the <em>cost </em><em>per partner notified and treated </em>(€74). The costs of ’Pee-in-a-pot’ screening were presented in terms of the <em>cost per negative case </em>(€39), the <em>cost per positive case </em><em>(€125)</em>, and the <em>cost per partner notified and treated </em>(€74).</p>
<p>In both analyses, screening was estimated to result in fewer major outcomes, fewer QALYs lost, and higher healthcare costs compared to the control strategy. The incremental cost effectiveness analyses indicated that screening in the Clinical Setting would result in an incremental cost per MO averted of €6,093 and an incremental cost per QALY gained of €94,717. ’Pee-in-a-pot’ screening was estimated to result in incremental cost effectiveness ratios of €2,294 per MO averted and €34,486 per QALY gained respectively.</p>
<p>In Ireland, there is no fixed and generally agreed cost effectiveness threshold below which health care technologies would be considered by policy makers to be costeffective. Nonetheless, on the basis of other technologies that are currently funded, it is not likely that screening delivered in the Clinical Setting, given an incremental cost per QALY in the region of the €94,717 found in this study, would be considered cost effective.</p>
<p>’Pee-in-a-pot’ screening in third level institution/college settings may be considered cost effective if a cost effectiveness threshold in the region of €45,000 per QALY gained is used. This is open to question, however, given the current economic climate and its resulting impact in terms of imposing further constraints on future healthcare budgets. It is also important to note that this strategy would have minimal in impact in reducing overall chlamydia prevalence in the population, if not supported by general population screening and prevention strategy.</p>