Prevention and Health Services, National Institute of Public Health and the Environment, Centre for Nutrition, Prevention and Health Services (VPZ), Bilthoven, the Netherlands Julius Center for Health Sciences and Primary Healthcare, University Medical Center, Utrecht, the Netherlands.
Prevention and Health Services, National Institute of Public Health and the Environment, Centre for Nutrition, Prevention and Health Services (VPZ), Bilthoven, the Netherlands.
Sex Transm Infect. 2015 Sep;91(6):423-9. doi: 10.1136/sextrans-2014-051677. Epub 2015 Mar 10.
In three pilot regions of The Netherlands, all 16-29 year olds were invited to participate in three annual rounds of Chlamydia screening. The aim of the present study is to evaluate the cost-effectiveness of repeated Chlamydia screening, based on empirical data.
A mathematical model was employed to estimate the influence of repeated screening on prevalence and incidence of Chlamydial infection. A model simulating the natural history of Chlamydia was combined with cost and utility data to estimate the number of major outcomes and quality-adjusted life-years (QALYs) associated with Chlamydia. Six screening scenarios (16-29 years annually; 16-24 years annually; women only; biennial screening; biennial screening women only; screening every five years) were compared with no screening in two sexual networks, representing both lower ('national network') and higher ('urban network') baseline prevalence. Incremental cost-effectiveness ratios (ICERs) for the different screening scenarios were estimated. Uncertainty and sensitivity analyses were performed.
In all scenarios and networks, cost per major outcome averted are above €5000. Cost per QALY are at least €50,000. The default scenario as piloted in the Netherlands was least cost-effective, with ICERs of €232,000 in the national and €145,000 in the urban sexual network. Results were robust in sensitivity analyses.
It is unlikely that repeated rounds of Chlamydia screening will be cost-effective. Only at high levels of willingness to pay for a QALY (>€50,000) screening may be more cost-effective than no screening.
在荷兰的三个试点地区，所有 16-29 岁的年轻人都被邀请参加三年度的衣原体筛查。本研究的目的是基于经验数据评估重复衣原体筛查的成本效益。
采用数学模型估计重复筛查对衣原体感染的患病率和发病率的影响。模拟衣原体自然史的模型与成本和效用数据相结合，以估计与衣原体相关的主要结局和质量调整生命年（QALYs）的数量。将六种筛查方案（每年 16-29 岁；每年 16-24 岁；仅女性；每两年筛查一次；仅女性每两年筛查一次；每五年筛查一次）与两个性网络（代表较低的“全国网络”和较高的“城市网络”）的不筛查情况进行比较。在两种性网络中，对不同的筛查方案进行了增量成本效益比（ICER）的估计。进行了不确定性和敏感性分析。
在所有方案和网络中，每避免一个主要结局的成本都高于 5000 欧元。每 QALY 的成本至少为 50000 欧元。荷兰试点默认方案是最不具有成本效益的，全国网络的 ICER 为 232000 欧元，城市网络的 ICER 为 145000 欧元。敏感性分析结果稳健。
重复进行衣原体筛查不太可能具有成本效益。只有在对 QALY（>50000 欧元）的支付意愿水平较高的情况下，筛查才可能比不筛查更具成本效益。
