Economic evaluation of the cost of different methods of retesting chlamydia positive individuals in England

Abstract

ObjectivesThe National Chlamydia Screening Programme (NCSP) in England opportunistically screens eligible individuals for chlamydia infection. Retesting is recommended three3 months after treatment following a positive test result, but no guidance is given on how local areas should recall individuals for retesting. Here , we compare cost estimates for different recall methods to inform the optimal delivery of retesting programmes.DesignEconomic evaluation.SettingEngland.MethodsWe estimated the cost of chlamydia retesting for each of the six most commonly used recall methods in 2014 based on existing cost estimates of a chlamydia screen. Proportions accepting retesting, opting for retesting by post, returning postal testing kits and retesting positive were informed by 2014 NCSP audit data. Health professionals ‘sense-checked’ the costs.Primary and secondary outcomesCost and adjusted cost per chlamydia retest; cost and adjusted cost per chlamydia retest positive.ResultsWe estimated the cost of the chlamydia retest pathway, including treatment/follow-up call, to be between £45 and £70 per completed test. At the lower end, this compared favourably to the cost of a clinic-based screen. Cost per retest positive was £389–£607. After adjusting for incomplete uptake, and non-return of postal kits, the cost rose to £109–£289 per completed test (cost per retest positive: £946–£2,506). The most economical method in terms of adjusted cost per retest was no active recall as gains in retest rates with active recall did not outweigh the higher cost. Nurse-led client contact by phone was particularly uneconomical, as was sending out postal testing kits automatically.ConclusionsRetesting without active recall is more economical than more intensive methods such as recalling by phone and automatically sending out postal kits. If sending a short message service (SMS) could be automated, this could be the most economical way of delivering retesting. However, patient choice and local accessibility of services should be taken into consideration in planning.

Analysis of chlamydia contacts and the look-back interval at a UK sexual health clinic

“…Contacts are initially identified following discussion with the index case and then reached out to via phone call, text messaging or post depending on available information. A look-back interval of fewer than six months, if safe, could reduce costs (1,339,931 CT tests in 15–24 year olds were taken in 2019 1 with an approximate cost of £45 per screening test 6 ); reduce workload (one study found the average time to trace a CT-positive contact was 6.8 h 7 ) and reduce empirical antibiotic treatment. Decreased antibiotic use will not only reduce medication side effects such as hypersensitivity, gastrointestinal issues and photosensitivity 8 and lower antibiotic resistance but may also reduce the risks associated with gut microbial dysbiosis.…”