The cost effectiveness of opportunistic chlamydia screening in England
The cost effectiveness of opportunistic chlamydia screening in England
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DOI：
10.1136/sti.2006.024364
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发表时间：
2007-07-01
影响因子：
3.6
通讯作者：
Edmunds, W. John
中科院分区：
文献类型：
--
作者：
Adams, Elisabeth J.;Turner, Katherine M. E.;Edmunds, W. John
背景/目的：英格兰正在实施国家衣原体筛查计划。本研究的目的是估计成本效益的（a）NCSP战略（每年提供的男性和女性年龄在25岁以下）和（B）替代screening strategies.Methods：一个随机的，基于个人的，动态的性网络模型相结合的成本效益模型，以估计衣原体感染的并发症和相关费用。该模型是从国家卫生服务（NHS）（英格兰）的角度构建和参数化的，包括感染，并发症和筛查的直接成本。单位成本来自标准数据来源和已发表的研究报告。估计了针对不同年龄组的女性和/或男性的衣原体筛查策略的平均和增量成本效益比（避免的主要结局或获得的质量调整生命年（QALY）的成本）。敏感性分析进行了探索模型的不确定性。结果：所有的筛查策略建模可能会花费NHS的钱，改善健康。如果盆腔炎（PID）进展小于10%，则在任何水平的筛查都不太可能是成本有效的。然而，如果PID进展为10%或更高，则与不筛查相比，NCSP策略似乎具有成本效益。增量成本效益分析表明，筛查年龄在20岁以下的男性和女性是最有益的战略，福尔斯低于接受的阈值。有一个高度的不确定性在findings.Conclusions：提供一个年度筛查测试，年龄在20岁以下的男性和女性可能是最具成本效益的策略（即，在接受的阈值），如果PID进展是10%或更高。
Background/aim: The National Chlamydia Screening Programme (NCSP) is being implemented in England. This study aims to estimate the cost effectiveness of (a) the NCSP strategy (annual screening offer to men and women aged under 25 years) and (b) alternative screening strategies.Methods: A stochastic, individual based, dynamic sexual network model was combined with a cost effectiveness model to estimate the complications and associated costs of chlamyclial infection. The model was constructed and parameterised from the perspective of the National Health Service (NHS) (England), including the direct costs of infection, complications and screening. Unit costs were derived from standard data sources and published studies. The average and incremental cost effectiveness ratio (cost per major outcome averted or quality adjusted life year (QALY) gained) of chlamydia screening strategies targeting women and/or men of different age groups was estimated. Sensitivity analyses were done to explore model uncertainty.Results: All screening strategies modelled are likely to cost the NHS money and improve health. if pelvic inflammatory disease (PID) progression is less than 10% then screening at any level is unlikely to be cost effective. However, if PID progression is 10% or higher the NCSP strategy compared to no screening appears to be cost effective. The incremental cost effectiveness analysis suggests that screening men and women aged under 20 years is the most beneficial strategy that falls below accepted thresholds. There is a high degree of uncertainty in the findings.Conclusions: Offering an annual screening test to men and women aged under 20 years may be the most cost effective strategy (that is, under accepted thresholds) if PID progression is 10% or higher.