The Cost-Effectiveness of Screening for Genital Chlamydial Infection in the UK
Adams, Elisabeth Jane;
(2007)
The Cost-Effectiveness of Screening for Genital Chlamydial Infection in the UK.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.00682366
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This PhD thesis explores the cost-effectiveness of Chlamydia trachomatis (CT) screening, in
the context of the National Chlamydia Screening Programme (NCSP) currently being
implemented in England. It uses statistical, mathematical and economic modelling techniques
and methods. The epidemiology ofCT in the UK is explored by identifying studies through a
systematic literature review. The data from them are extracted and analysed using regression
techniques and CT prevalence is estimated, indicating a high burden in young women in
health care settings. The prevalence estimates are used along with data on past CT treatment
and sexual mixing behaviour to parameterise an individual-based dynamic mathematical
model of CT transmission:' An extensive fitting process identified parameter values that
generated realistic epidemiology and sexual behaviour, to optimise public health applicability
ofthe model.
The cost of offering CT screening is estimated based on empirical data from a screening
study. The flow of patients through a screening programme is modelled and the associated
costs of testing and treatment of positives are estimated. Results from the sensitivity analyses
indicate that the proportion of individuals accepting a screening offer has the biggest impact
on the results, and highlight how costs could be minimised. In the final analysis, results ofthe
parameterised dynamic model are combined with an economic model of disease progression
and costs to estimate the cost-effectiveness of the NCSP strategy and alternatives. Results
indicate that the current NCSP strategy (screen women and men aged under 25 years) may be
cost-effective when compared to no screening, but that alternate, less inclusive strategies may
be more acceptable on cost-effectiveness grounds. Assumptions about the progression from
CT to pelvic inflammatory disease have the largest impact on the results