One to one interventions to reduce sexually transmitted infections and under the age of 18 conceptions: a systematic review of the economic evaluations

Abstract

Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area.

A national strategic plan for reducing the burden of sexually transmitted infections in Israel by the year 2025

“…The recommendation to screen pregnant women is based upon observational evidence that screening decreases the proportion of newborns with clinical manifestations of syphilis infection and those with positive serology [ 23 ]. Cost-Effectiveness In a review of 55 cost-effectiveness studies focused primarily on Chlamydia and HIV interventions, one-on-one interventions such as counseling (and screening) were proven to be cost-effective [ 24 ]. An editorial on the article [ 25 ] noted that these cost-effectiveness calculations were conservative because the benefits of STI prevention such as reduction of HIV incidence and productivity losses were excluded.…”

“…In a review of 55 cost-effectiveness studies focused primarily on Chlamydia and HIV interventions, one-on-one interventions such as counseling (and screening) were proven to be cost-effective [ 24 ]. An editorial on the article [ 25 ] noted that these cost-effectiveness calculations were conservative because the benefits of STI prevention such as reduction of HIV incidence and productivity losses were excluded.…”

Opt-out Testing Pilot for Sexually Transmitted Infections Among Immigrant Detainees at 2 Immigration and Customs Enforcement Health Service Corps–Staffed Detention Facilities, 2018

“…However, many other STI screening programs, especially those focusing on chlamydia, have been touted as cost effective. 21,24,25 Staff members' time comprised 51% to 56% of our calculated cost, a portion attributed to pre-and posttesting counseling. We felt it was important to invest these resources to maximize participation in the program and to ensure detainees had sufficient information to make informed choices.…”

An Economic Model of School-Based Behavioral Interventions to Prevent Sexually Transmitted Infections

“…The difference in the results between these two studies may be partly explained by the fact that Wang et al (26) included the effects of the intervention on other STIs and unintended pregnancy; while these effects were not included by Cohen et al (6) The current study incorporated the impact of changes in HRQoL to individuals from the STIs to present the results in terms of cost per QALYs gained, which are commonly used by health decision makers (18). Few studies that have estimated the cost-effectiveness of interventions to prevent STIs have used estimates of QALYs (2). Rather, they have used other outcome measures such as cost per major outcome averted or cost per case avoided (16;26), which makes them more difficult to compare with other health interventions, and involves making assumptions such as assuming that all STIs have equal health consequences, which is unlikely to be the case.…”