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A cost-effectiveness analysis of condom distribution programmes for the prevention of sexually transmitted infections in England
  1. Susannah Sadler1,2,
  2. Jon Tosh1,
  3. Rebekah Pennington3,
  4. Andrew Rawdin1,
  5. Hazel Squires1,
  6. Carmen Romero4,
  7. Alastair Fischer5,
  8. James Chilcott1
  1. 1School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2University of Exeter Medical School, University of Exeter, Exeter, UK
  3. 3Centre for Guidelines, National Institute for Health and Care Excellence, Manchester, UK
  4. 4Center for Technological Development in Health, National Institute for Science and Technology on Innovation on Neglected Diseases, Rio de Janeiro, Brazil
  5. 5The Office of Health Economics, London, UK
  1. Correspondence to Susannah Sadler, University of Exeter Medical School, University of Exeter, Exeter, UK; s.e.sadler{at}exeter.ac.uk

Abstract

Background Prevention of sexually transmitted infection (STI) incidence in England is a high priority, particularly among young people, men who have sex with men (MSM) and black ethnic minorities. An economic evaluation of condom distribution programmes (CDPs) to reduce STI transmission is presented.

Methods An economic model using a Bernoulli process estimated the number of people acquiring an STI as a function of its prevalence, transmission rate, condom use, condom failure rate and number of sexual contacts. Models were developed for young people (13–24 years), black ethnic minorities, MSM and the general English population. Effectiveness evidence came from a recent systematic review. For young people, a CDP was modelled (relative risk for condom use=1.23), along with an exploratory analysis of the impact on unintended pregnancies. For other populations, threshold analyses were used to identify the combination of costs and effect size required to make a programme cost-effective.

Results The base case predicted that CDP for all young people in England could avert 5123 STI cases per annum, with an incremental cost–effectiveness ratio of £17 411. In addition, it could avert 118 pregnancies and 82 abortions and save £333 000 in associated costs. Schemes for black ethnic minorities and MSM could also be cost-effective even with relatively high costs and small effect sizes.

Conclusion CDPs for young people are likely to be cost-effective or cost-saving. CDPs for other high-risk populations may also be cost-effective if they can increase condom use, since high HIV prevalence in these groups imposes a considerable health and cost burden.

  • SEXUALLY TRANS DIS
  • SEXUAL HEALTH
  • PUBLIC HEALTH POLICY
  • PUBLIC HEALTH
  • Economic evaluation

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Footnotes

  • Contributors SS, JT, HS, AR and JC contributed to model design, parameterisation and generation of outputs. All authors advised on the work and contributed to the production of the manuscript.

  • Funding This work was funded by the UK National Institute forHealth and Care Excellence.

  • Competing interests RP is considered to be a government employee since she works for the National Institute of Health and Care Excellence (NICE), a publicly funded body sponsored by the UK government’s Department of Health. Rest of the authors have no competing interests to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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