Chlamydia sequelae cost estimates used in current economic evaluations: does one-size-fit-all?

Area of Science:

• Public Health
• Health Economics
• Infectious Disease Epidemiology

Background:

• Chlamydia screening programs are considered potentially cost-effective.
• Mathematical models underpin cost-effectiveness assumptions.
• Economic evaluations of chlamydia screening vary across seven countries.

Purpose of the Study:

• To explore differences in cost estimates for chlamydia sequelae management.
• To compare the influence of sequelae and their costs on overall economic evaluations.
• To standardize cost estimates to 2013/2014 Great British Pound (GBP) values.

Main Methods:

• Extracted management costs for seven major chlamydia sequelae from published studies.
• Applied reported unit sequelae management costs to infection-to-sequela progression probabilities.
• Adjusted all costs to 2013/2014 Great British Pound (GBP) values for comparability.

Main Results:

• Sequelae management costs varied widely: pelvic inflammatory disease (£171–£3635), ectopic pregnancy (£953–£3615), tubal factor infertility (£546–£6752), chronic pelvic pain (£159–£3341), epididymitis (£22–£1008), neonatal conjunctivitis (£11–£1459), and neonatal pneumonia (£433–£3992).
• Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412.
• Substantial variation exists in cost per case estimates.

Conclusions:

• Significant variation in cost per case of chlamydia sequelae was observed in economic evaluations.
• Discrepancies likely stem from differing assumptions on disease management pathways and country perspectives.
• Readers should critically assess cost estimates for relevance to specific contexts and current disease management practices.