The cost-effectiveness of accelerated partner therapy (APT) compared to standard contact tracing for people with chlamydia: an economic evaluation based on the LUSTRUM population-based chlamydia transmission model

Abstract

Objective: To investigate the cost-effectiveness of accelerated partner therapy (APT) compared with standard contact tracing for people with sexually transmitted chlamydia infection in the United Kingdom Design: Economic evaluation using a model consisting of two components: a population-based chlamydia transmission component, to estimate the impact of APT on chlamydia prevalence, and an economic component, to estimate the impact of APT on healthcare costs and health outcomes. Setting: United Kingdom Participants: Hypothetical heterosexual population of 50,000 men and 50,000 women aged 16-34 years. Main Outcome Measures: Cost-effectiveness based on quality-adjusted life years (QALYs) gained and major outcomes averted (MOA), defined as mild pelvic inflammatory disease (PID), severe PID, chronic pelvic pain, ectopic pregnancy, tubal factor infertility and epididymitis. Results: For a model population of 50,000 men and 50,000 women and an APT intervention lasting 5 years, the intervention cost of APT (&pound135,201) is greater than the intervention cost of standard contact tracing (&pound116,334). When the costs of complications arising from chlamydia are considered, the total cost of APT (&pound370,657) is lower than standard contact tracing (&pound379,597). Thus, APT yields a total cost saving of approximately &pound9000 and leads to 73 fewer major outcomes and 21 fewer QALYs lost. Hence, APT is the dominant PN strategy. APT remained cost-effective across the full range of sensitivity analyses. Conclusions: Based on cost-effectiveness grounds APT is likely to be recommended as an alternative to standard contact tracing for chlamydia infection in the United Kingdom

Accelerated partner therapy contact tracing for people with chlamydia (LUSTRUM): a crossover cluster-randomised controlled trial

“…37 partner notification in terms of major outcomes averted and quality-adjusted life-years gained, is reported elsewhere. 33 Detailed findings of the process evaluation are reported elsewhere. 31 Clinics operationalised the trial differently; some aimed to offer accelerated partner therapy to all potentially eligible patients, whereas others only offered accelerated partner therapy when certain staff were present.…”

“…29,30 The protocol for the trial, 27 an integral process evaluation, 31 and preliminary health economics analysis based on transmission dynamic modelling 32 are presented elsewhere. 33 We chose this study design because individual randomisation carried a high risk of contamination of the intervention and was operationally unfeasible; service-level consent 27 aimed to make delivery of the intervention more realistic in busy clinical settings; and the crossover design allowed all clinics to test the accelerated partner therapy intervention and provided efficiencies in patient enrolment. All patients could opt out of the research through a novel pragmatic opt-out process, 34 but none did so, and none opted out of their data being used for research purposes.…”

“…The health economic evaluation included a costconsequence analysis (appendix pp 11-18) and modelbased cost-effectiveness analysis, reported separately. 33 We also did a process evaluation. 31…”

“…The preliminary analysis suggests that accelerated partner therapy might be cost-saving compared with usual care. 33 Of note, the linked modelling study suggests that there is potential for reduction in prevalence of chlamydia at the population level. 32 We attribute the modest effect sizes, in part, to the smaller than expected numbers of index patients choosing accelerated partner therapy for their partners.…”

Priorities in the implementation of partner services for HIV/STIs in high-income nations: a narrative review of evidence and recommendations

“…The authors concluded that APT can be safely offered as a cost-saving contact tracing option for heterosexual people with chlamydia, and might reduce the risk of repeat infection, particularly for those in emotionally connected relationships, although uptake needs to be improved and novel approaches are needed for one-off partners. [33][34][35]…”