Chlamydia screening for pregnant women aged 16–25 years attending an antenatal service: a cost‐effectiveness study

Objective Determine the cost‐effectiveness of screening all pregnant women aged 16–25 years for chlamydia compared with selective screening or no screening. Design Cost effectiveness based on a decision model. Setting Antenatal clinics in Australia. Sample Pregnant women, aged 16–25 years. Methods U...

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology 2016-06, Vol.123 (7), p.1194-1202
Main Authors: Ong, JJ, Chen, M, Hocking, J, Fairley, CK, Carter, R, Bulfone, L, Hsueh, A
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antenatal
Australia
Benefit cost analysis
Chlamydia
Chlamydia Infections - diagnosis
Chlamydia Infections - economics
Chlamydia trachomatis
Cost analysis
Cost control
Cost-Benefit Analysis
cost‐effectiveness
Early Diagnosis
Female
Health care expenditures
Humans
Medical screening
Models, Economic
Obstetrics
Pelvic inflammatory disease
Pregnancy
Pregnancy Complications, Infectious - diagnosis
Pregnancy Complications, Infectious - economics
Prenatal care
Prenatal Diagnosis - economics
Quality-Adjusted Life Years
screening
Sensitivity analysis
Sexually transmitted diseases
STD
Young Adult
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Summary:Objective Determine the cost‐effectiveness of screening all pregnant women aged 16–25 years for chlamydia compared with selective screening or no screening. Design Cost effectiveness based on a decision model. Setting Antenatal clinics in Australia. Sample Pregnant women, aged 16–25 years. Methods Using clinical data from a previous study, and outcomes data from the literature, we modelled the short‐term perinatal (12‐month time horizon) incremental direct costs and outcomes from a government (as the primary third‐party funder) perspective for chlamydia screening. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and average cost‐weights reported for hospitalisations classified according to the Australian refined diagnosis‐related groups. Main outcome measures Direct costs of screening and managing chlamydia complications, number of chlamydia cases detected and treated, and the incremental cost‐effectiveness ratios were estimated and subjected to sensitivity analyses. Results Assuming a chlamydia prevalence rate of 3%, screening all antenatal women aged 16–25 years at their first antenatal visit compared with no screening was $34,931 per quality‐adjusted life‐years gained. Screening all women could result in cost savings when chlamydia prevalence was higher than 11%. The incremental cost‐effectiveness ratios were most sensitive to the assumed prevalence of chlamydia, the probability of pelvic inflammatory disease, the utility weight of a positive chlamydia test and the cost of the chlamydia test and doctor's appointment. Conclusion From an Australian government perspective, chlamydia screening of all women aged 16–25 years old during one antenatal visit was likely to be cost‐effective compared with no screening or selective screening, especially with increasing chlamydia prevalence. Tweetable Chlamydia screening for all pregnant women aged 16–25 years during an antenatal visit is cost effective. Tweetable Chlamydia screening for all pregnant women aged 16–25 years during an antenatal visit is cost effective.
ISSN:1470-0328
1471-0528
DOI:10.1111/1471-0528.13567