Sadler Susannah, Tosh Jon, Pennington Rebekah, Rawdin Andrew, Squires Hazel, Romero Carmen, Fischer Alastair, Chilcott James
School of Health and Related Research, University of Sheffield, Sheffield, UK.
University of Exeter Medical School, University of Exeter, Exeter, UK.
J Epidemiol Community Health. 2017 Sep;71(9):897-904. doi: 10.1136/jech-2017-209020. Epub 2017 Jul 5.
Prevention of sexually transmitted infection (STI) incidence in England is a high priority, particularly among young people, men who have sex with men (MSM) and black ethnic minorities. An economic evaluation of condom distribution programmes (CDPs) to reduce STI transmission is presented.
An economic model using a Bernoulli process estimated the number of people acquiring an STI as a function of its prevalence, transmission rate, condom use, condom failure rate and number of sexual contacts. Models were developed for young people (13-24 years), black ethnic minorities, MSM and the general English population. Effectiveness evidence came from a recent systematic review. For young people, a CDP was modelled (relative risk for condom use=1.23), along with an exploratory analysis of the impact on unintended pregnancies. For other populations, threshold analyses were used to identify the combination of costs and effect size required to make a programme cost-effective.
The base case predicted that CDP for all young people in England could avert 5123 STI cases per annum, with an incremental cost-effectiveness ratio of £17 411. In addition, it could avert 118 pregnancies and 82 abortions and save £333 000 in associated costs. Schemes for black ethnic minorities and MSM could also be cost-effective even with relatively high costs and small effect sizes.
CDPs for young people are likely to be cost-effective or cost-saving. CDPs for other high-risk populations may also be cost-effective if they can increase condom use, since high HIV prevalence in these groups imposes a considerable health and cost burden.
预防英格兰的性传播感染（STI）发病率是一项高度优先事项，尤其是在年轻人、男男性行为者（MSM）和少数族裔中。本文对旨在减少性传播感染传播的避孕套分发计划（CDP）进行了经济评估。
使用伯努利过程的经济模型估计感染性传播感染的人数，该人数是其流行率、传播率、避孕套使用情况、避孕套失败率和性接触次数的函数。针对年轻人（13 - 24岁）、少数族裔、男男性行为者和英格兰普通人群建立了模型。有效性证据来自最近的一项系统评价。对于年轻人，对一项避孕套分发计划进行了建模（使用避孕套的相对风险 = 1.23），并对其对意外怀孕的影响进行了探索性分析。对于其他人群，采用阈值分析来确定使一项计划具有成本效益所需的成本和效应大小的组合。
基础案例预测，英格兰所有年轻人的避孕套分发计划每年可避免5123例性传播感染病例，增量成本效益比为17411英镑。此外，它还可避免118例怀孕和82例堕胎，并节省33.3万英镑的相关成本。即使成本相对较高且效应大小较小，少数族裔和男男性行为者的计划也可能具有成本效益。
针对年轻人的避孕套分发计划可能具有成本效益或节省成本。如果其他高危人群的避孕套分发计划能够增加避孕套的使用，那么这些计划也可能具有成本效益，因为这些人群中艾滋病毒的高流行率带来了相当大的健康和成本负担。
