An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK

J. E. Norman, O. Wu, S. Twaddle, L. McMillan, Alexander Allan Templeton, Hamish McKenzie, A. Noone, G. Allardice, M. Reid

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics.

Design Cost effectiveness based on decision model. Model probabilities were generated for a hypothetical sample of 250 women in each age group in each setting, based on prevalence studies, published data and expert opinion. A prospective observational study was used to generate data on prevalence and acceptability.

Setting Antenatal, gynaecology and family planning clinics in Aberdeen, Edinburgh and Glasgow.

Sample Prevalence was estimated in 2817 women. Acceptability was determined in 484 women.

Methods An economic evaluation was performed using prevalence data from this and a previous study, and using outcome data from the literature and observational work. Incremental cost effectiveness ratios were estimated for each age group and clinical setting. Sensitivity analyses were performed to determine the robustness of incremental cost effectiveness ratios to changes in the incidence of long term sequelae and costs. The prevalence of infection was determined by nucleic acid amplification of urine samples or endocervical swabs. Knowledge of C. trachomatis and women's views of screening were determined using structured questionnaires.

Main outcome measures Direct health service costs of screening, incidence and costs associated with adverse sequelae, women's views of screening and prevalence of infection.

Results The estimated cost of screening 250 women in each age group in each the four sample populations (total population of 3750) is pound49,367, while preventing 64 major sequelae. This represents a net cost of pound771.36 in preventing one major sequela. Selective screening of all women under 20 years and all patients attending abortion clinics were shown to be the most cost effective strategies. These results were relatively insensitive to changes in estimated parameters, such as uptake rate, probabilities and unit costs of all major sequlae averted. Prevalence (95% CI) of infection in the highest risk groups (those aged under 20 in both antenatal and abortion clinics) was 12.1% (8.6-16.7) and 12.7% (7.3-21.2), respectively. The majority (>95%) of women agreed with a policy of regular screening for C. trachomatis, and screening in the settings employed in this study was largely acceptable.

Conclusions A single episode of screening for C. trachomatis does not result in net cost savings. Currently recommended strategies of screening for C. trachomatis in women under 25 years of age in abortion clinics are supported by our data on prevalence and acceptability. These data also suggest that hospital-based screening strategies should be further extended to include younger women attending antenatal clinics and all women of reproductive age attending colposcopy clinics.

Original languageEnglish
Pages (from-to)1261-1268
Number of pages7
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume111
DOIs
Publication statusPublished - Nov 2004

Keywords

  • PELVIC-INFLAMMATORY-DISEASE
  • COST-EFFECTIVENESS
  • TRACT INFECTIONS
  • FOLLOW-UP
  • HEALTH
  • PREVENTION
  • PREVALENCE
  • UPDATE

Cite this

An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK. / Norman, J. E.; Wu, O.; Twaddle, S.; McMillan, L.; Templeton, Alexander Allan; McKenzie, Hamish; Noone, A.; Allardice, G.; Reid, M.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 111, 11.2004, p. 1261-1268.

Research output: Contribution to journalArticle

@article{40b0f1570fa84a279f80b1aa96782441,
title = "An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK",
abstract = "Objective The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics.Design Cost effectiveness based on decision model. Model probabilities were generated for a hypothetical sample of 250 women in each age group in each setting, based on prevalence studies, published data and expert opinion. A prospective observational study was used to generate data on prevalence and acceptability.Setting Antenatal, gynaecology and family planning clinics in Aberdeen, Edinburgh and Glasgow.Sample Prevalence was estimated in 2817 women. Acceptability was determined in 484 women.Methods An economic evaluation was performed using prevalence data from this and a previous study, and using outcome data from the literature and observational work. Incremental cost effectiveness ratios were estimated for each age group and clinical setting. Sensitivity analyses were performed to determine the robustness of incremental cost effectiveness ratios to changes in the incidence of long term sequelae and costs. The prevalence of infection was determined by nucleic acid amplification of urine samples or endocervical swabs. Knowledge of C. trachomatis and women's views of screening were determined using structured questionnaires.Main outcome measures Direct health service costs of screening, incidence and costs associated with adverse sequelae, women's views of screening and prevalence of infection.Results The estimated cost of screening 250 women in each age group in each the four sample populations (total population of 3750) is pound49,367, while preventing 64 major sequelae. This represents a net cost of pound771.36 in preventing one major sequela. Selective screening of all women under 20 years and all patients attending abortion clinics were shown to be the most cost effective strategies. These results were relatively insensitive to changes in estimated parameters, such as uptake rate, probabilities and unit costs of all major sequlae averted. Prevalence (95{\%} CI) of infection in the highest risk groups (those aged under 20 in both antenatal and abortion clinics) was 12.1{\%} (8.6-16.7) and 12.7{\%} (7.3-21.2), respectively. The majority (>95{\%}) of women agreed with a policy of regular screening for C. trachomatis, and screening in the settings employed in this study was largely acceptable.Conclusions A single episode of screening for C. trachomatis does not result in net cost savings. Currently recommended strategies of screening for C. trachomatis in women under 25 years of age in abortion clinics are supported by our data on prevalence and acceptability. These data also suggest that hospital-based screening strategies should be further extended to include younger women attending antenatal clinics and all women of reproductive age attending colposcopy clinics.",
keywords = "PELVIC-INFLAMMATORY-DISEASE, COST-EFFECTIVENESS, TRACT INFECTIONS, FOLLOW-UP, HEALTH, PREVENTION, PREVALENCE, UPDATE",
author = "Norman, {J. E.} and O. Wu and S. Twaddle and L. McMillan and Templeton, {Alexander Allan} and Hamish McKenzie and A. Noone and G. Allardice and M. Reid",
year = "2004",
month = "11",
doi = "10.1111/j.1471-0528.2004.00324.x",
language = "English",
volume = "111",
pages = "1261--1268",
journal = "BJOG-An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "John Wiley & Sons, Ltd (10.1111)",

}

TY - JOUR

T1 - An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK

AU - Norman, J. E.

AU - Wu, O.

AU - Twaddle, S.

AU - McMillan, L.

AU - Templeton, Alexander Allan

AU - McKenzie, Hamish

AU - Noone, A.

AU - Allardice, G.

AU - Reid, M.

PY - 2004/11

Y1 - 2004/11

N2 - Objective The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics.Design Cost effectiveness based on decision model. Model probabilities were generated for a hypothetical sample of 250 women in each age group in each setting, based on prevalence studies, published data and expert opinion. A prospective observational study was used to generate data on prevalence and acceptability.Setting Antenatal, gynaecology and family planning clinics in Aberdeen, Edinburgh and Glasgow.Sample Prevalence was estimated in 2817 women. Acceptability was determined in 484 women.Methods An economic evaluation was performed using prevalence data from this and a previous study, and using outcome data from the literature and observational work. Incremental cost effectiveness ratios were estimated for each age group and clinical setting. Sensitivity analyses were performed to determine the robustness of incremental cost effectiveness ratios to changes in the incidence of long term sequelae and costs. The prevalence of infection was determined by nucleic acid amplification of urine samples or endocervical swabs. Knowledge of C. trachomatis and women's views of screening were determined using structured questionnaires.Main outcome measures Direct health service costs of screening, incidence and costs associated with adverse sequelae, women's views of screening and prevalence of infection.Results The estimated cost of screening 250 women in each age group in each the four sample populations (total population of 3750) is pound49,367, while preventing 64 major sequelae. This represents a net cost of pound771.36 in preventing one major sequela. Selective screening of all women under 20 years and all patients attending abortion clinics were shown to be the most cost effective strategies. These results were relatively insensitive to changes in estimated parameters, such as uptake rate, probabilities and unit costs of all major sequlae averted. Prevalence (95% CI) of infection in the highest risk groups (those aged under 20 in both antenatal and abortion clinics) was 12.1% (8.6-16.7) and 12.7% (7.3-21.2), respectively. The majority (>95%) of women agreed with a policy of regular screening for C. trachomatis, and screening in the settings employed in this study was largely acceptable.Conclusions A single episode of screening for C. trachomatis does not result in net cost savings. Currently recommended strategies of screening for C. trachomatis in women under 25 years of age in abortion clinics are supported by our data on prevalence and acceptability. These data also suggest that hospital-based screening strategies should be further extended to include younger women attending antenatal clinics and all women of reproductive age attending colposcopy clinics.

AB - Objective The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics.Design Cost effectiveness based on decision model. Model probabilities were generated for a hypothetical sample of 250 women in each age group in each setting, based on prevalence studies, published data and expert opinion. A prospective observational study was used to generate data on prevalence and acceptability.Setting Antenatal, gynaecology and family planning clinics in Aberdeen, Edinburgh and Glasgow.Sample Prevalence was estimated in 2817 women. Acceptability was determined in 484 women.Methods An economic evaluation was performed using prevalence data from this and a previous study, and using outcome data from the literature and observational work. Incremental cost effectiveness ratios were estimated for each age group and clinical setting. Sensitivity analyses were performed to determine the robustness of incremental cost effectiveness ratios to changes in the incidence of long term sequelae and costs. The prevalence of infection was determined by nucleic acid amplification of urine samples or endocervical swabs. Knowledge of C. trachomatis and women's views of screening were determined using structured questionnaires.Main outcome measures Direct health service costs of screening, incidence and costs associated with adverse sequelae, women's views of screening and prevalence of infection.Results The estimated cost of screening 250 women in each age group in each the four sample populations (total population of 3750) is pound49,367, while preventing 64 major sequelae. This represents a net cost of pound771.36 in preventing one major sequela. Selective screening of all women under 20 years and all patients attending abortion clinics were shown to be the most cost effective strategies. These results were relatively insensitive to changes in estimated parameters, such as uptake rate, probabilities and unit costs of all major sequlae averted. Prevalence (95% CI) of infection in the highest risk groups (those aged under 20 in both antenatal and abortion clinics) was 12.1% (8.6-16.7) and 12.7% (7.3-21.2), respectively. The majority (>95%) of women agreed with a policy of regular screening for C. trachomatis, and screening in the settings employed in this study was largely acceptable.Conclusions A single episode of screening for C. trachomatis does not result in net cost savings. Currently recommended strategies of screening for C. trachomatis in women under 25 years of age in abortion clinics are supported by our data on prevalence and acceptability. These data also suggest that hospital-based screening strategies should be further extended to include younger women attending antenatal clinics and all women of reproductive age attending colposcopy clinics.

KW - PELVIC-INFLAMMATORY-DISEASE

KW - COST-EFFECTIVENESS

KW - TRACT INFECTIONS

KW - FOLLOW-UP

KW - HEALTH

KW - PREVENTION

KW - PREVALENCE

KW - UPDATE

U2 - 10.1111/j.1471-0528.2004.00324.x

DO - 10.1111/j.1471-0528.2004.00324.x

M3 - Article

VL - 111

SP - 1261

EP - 1268

JO - BJOG-An International Journal of Obstetrics and Gynaecology

JF - BJOG-An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

ER -