Assessing the costs and outcomes of control programmes for sexually transmitted infections: a systematic review of economic evaluations

Sonja Charlotte Margot Bloch, Louise Jackson, Emma Frew, Jonathan D C Ross

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Objective: To identify economic evaluations of interventions to control sexually transmitted infections (STIs) and HIV targeting young people, and to assess how costs and outcomes are measured in these studies.
Design: Systematic review.

Data sources: Seven databases were searched (Medline (Ovid), EMBASE (Ovid), Web of Science, PsycINFO, NHS EED, NHS HTA, and DARE) from January 1999 to April 2019. Key search terms were STIs (chlamydia, gonorrhoea, syphilis) and HIV, cost benefit, cost utility, economic evaluation, public health, screening, testing, and control.

Review methods: Studies were included that measured costs and outcomes to inform an economic evaluation of any programme to control STIs and HIV targeting individuals predominantly below 30 years of age at risk of, or affected by, one or multiple STIs and/or HIV in OECD countries. Data was extracted and tabulated and included study results and characteristics of economic evaluations. Study quality was assessed using the Philips and BMJ checklists. Results were synthesised narratively.

Results: 9,530 records were screened and categorised. Of these, 31 were included for data extraction and critical appraisal. The majority of studies assessed the cost-effectiveness or cost-utility of screening interventions for chlamydia from a provider perspective. The main outcome measures were major outcomes averted and quality-adjusted life years. Studies evaluated direct medical costs, e.g. programme costs and eleven included indirect costs, such as productivity losses. The study designs were predominantly model-based with significant heterogeneity between the models.

Discussion/Conclusion: None of the economic evaluations encompassed aspects of equity or context, which are highly relevant to sexual health decision-makers. The review demonstrated heterogeneity in approaches to evaluate costs and outcomes for STI/HIV control programmes. The low quality of available studies along with the limited focus, i.e. almost all studies relate to chlamydia, highlight the need for high-quality economic evaluations to inform the commissioning of sexual health services
Original languageEnglish
Pages (from-to)334-344
JournalSexually Transmitted Infections
Issue number5
Early online date2 Mar 2021
Publication statusE-pub ahead of print - 2 Mar 2021


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