Volume 21, Number 6—June 2015
Research
Cost-effectiveness of Chlamydia Vaccination Programs for Young Women
Table 1
Parameter | Value (range) |
Reference | |
---|---|---|---|
Men | Women | ||
Duration of symptomatic infection, d | 14 (10–21) | 28 (10–35) | (15,16) |
Duration of asymptomatic infection, d | 182.5 (120–240) | 365 (240–480) | (15,16) |
Incubation period, d | 14 (7–21) | 14 (7–21) | (15,16) |
Duration of sequelae, d | 21 (10–30) | 60 (45–75) | (16) |
Probability of sequelae, % | 2 (0–5) | 15 (10–20) | (16,18) |
Per-partnership transmission probability, % | 70 (25–80) | 68 (25–80) | (19) |
Probability of symptomatic infection, % | 50 (20–80) | 20 (10–50) | (15,16) |
Average no. partners in past year, high sexual activity | 13.30 (10.00–16.00) | 33.26 (30.00–40.00) | (15,16,20) |
Average no. partners in past year, low sexual activity | 0.90 (0.60–1.20) | 0.88 (0.60–1.50) | (15,16,20) |
Proportion in low sexual activity class, % | 95.0 (90.0–99.0) | 97.9 (95.0–99.0) | (15,16,20) |
Annual screening rate, % | 0 | 30 (10–50) | (15) |
Probability of postscreening treatment, % | 80 (50–99) | 80 (50–99) | (15) |
Probability of treatment, symptomatic, % | 89 (80–100) | 89 (80–100) | (4) |
Test sensitivity, % | 95 (90–100) | 95 (90–100) | (21) |
Test specificity, % | 99 (95–100) | 99 (95–100) | (21) |
Treatment efficacy (doxycycline, azithromycin), % | 92 (80–100) | 92 (80–100) | (15,22) |
QALYs lost/case | |||
Symptomatic infection | 0.005646 ± 50% | 0.009913 (± 50%) | (16) |
Sequelae† | 0.009530 ± 50% | 0.497580 (± 50%) | (16) |
Costs (2013 US Dollars) | |||
Treatment of acute chlamydia‡ | 185.2 ± 50% | 183.0 (± 50%) | (4,23–25) |
Sequelae† | 1,337 ± 50% | 4,516 (± 50%) | (4,16,26) |
Screening | 55 ± 50% | 55 (± 50%) | (4,23) |
Vaccination | 547 ± 50% | 547 (± 50%) | Model assumption |
Vaccine coverage, 14-y-old persons, % | 0 | 30 (10–50) | Model assumption (27) |
Vaccine coverage, 15–24-y-old persons, % | 0 | 30 | Model assumption (27) |
Vaccine efficacy, % | 75 (50–100) | 75 (50–100) | Model assumption (27) |
Duration of vaccine-conferred immunity, y | 10 (1–100) | 10 (1–100) | Model assumption |
Duration of infection-conferred immunity, y | 1 (0.5–5.0) | 1 (0.5–5.0) | (17) |
Relative size of the 14-y-old population entering model compared with overall population model, % | 10 (5–15) | Model assumption | |
Sexual mixing parameter§ | 0.50 (0.10–0.90) | Model assumption | |
Discount rate, % | 3 (0–10) | Model assumption |
*QALYs, quality-adjusted life years.
†Includes productivity costs or QALYs (where applicable) for epididymitis for men and complications associated with pelvic inflammatory diseases (i.e., chronic pelvic pain, ectopic pregnancy, and infertility) for women.
‡Includes productivity costs associated with acute chlamydia and seeking treatment (24) and the reported youth (16–24-y-old persons) employment rate in 2010 (48.9%) (25).
§Used to determine the degree of mixing between the 2 (high and low) sexual activity groups (0, random mixing; 1, fully assortative).
References
- World Health Organization. Global incidence and prevalence of selected curable sexually transmitted infections, 2008. Geneva: The Organization; 2012.
- Centers for Disease Control and Prevention. Sexually transmitted disease surveillance, 2012. Atlanta: The Centers; 2013.
- Satterwhite CL, Torrone E, Meitis E, Dunne EF, Mahajan R, Ocfemia MC, Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187–93. DOIPubMedGoogle Scholar
- Owusu-Edusei K Jr, Chesson HW, Gift TL, Tao G, Ocfemia MC, Mahajan R, The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197–201. DOIPubMedGoogle Scholar
- Stamm WE. Chlamydia trachomatis infections in the adult. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al., editors. Sexually transmitted diseases. New York: McGraw Hill; 2008. p. 575–93.
- Bakken IJ, Skjeldestad FE, Nordbo SA. Chlamydia trachomatis infections increase the risk for ectopic pregnancy: A population-based, nested case-control study. Sex Transm Dis. 2007;34:166–9. DOIPubMedGoogle Scholar
- Hafner LM, Wilson DP, Timms P. Development status and future prospects for a vaccine against Chlamydia trachomatis infection. Vaccine. 2014;32:1563–71. DOIPubMedGoogle Scholar
- Brunham RC, Rappuoli R. Chlamydia trachomatis control requires a vaccine. Vaccine. 2013;31:1892–7. DOIPubMedGoogle Scholar
- Geisler WM, Morrison SG, Doemland ML, Iqbal SM, Su J, Mancevski A, Immunoglobulin-specific responses to Chlamydia elementary bodies in individuals with and at risk for genital chlamydial infection. J Infect Dis. 2012;206:1836–43. DOIPubMedGoogle Scholar
- Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine. 2014;32:1527–35. DOIPubMedGoogle Scholar
- Chesson HW, Ekwueme DU, Saraiya M, Dunne EF, Markowitz LE. The cost-effectiveness of male HPV vaccination in the United States. Vaccine. 2011;29:8443–50. DOIPubMedGoogle Scholar
- Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE. Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008;14:244–51. DOIPubMedGoogle Scholar
- Elbasha EH, Dasbach EJ, Insinga RP. Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007;13:28–41. DOIPubMedGoogle Scholar
- Kim JJ, Goldie SJ. Health and economic implications of HPV vaccination in the United States. N Engl J Med. 2008;359:821–32. DOIPubMedGoogle Scholar
- Owusu-Edusei K Jr, Gift TL, Chesson HW, Kent CK. Investigating the potential public health benefit of jail-based screening and treatment programs for Chlamydia. Am J Epidemiol. 2013;177:463–73. DOIPubMedGoogle Scholar
- Gift TL, Gaydos CA, Kent CK, Marrazzo JM, Rietmeijer CA, Schillinger JA, The program cost and cost-effectiveness of screening men for Chlamydia to prevent pelvic inflammatory disease in women. Sex Transm Dis. 2008;35(Suppl):S66–75. DOIPubMedGoogle Scholar
- Brunham RC, Pourbohloul B, Mak S, White R, Rekart ML. The unexpected impact of a Chlamydia trachomatis infection control program on susceptibility to reinfection. J Infect Dis. 2005;192:1836–44. DOIPubMedGoogle Scholar
- Price MJ, Ades AE, De Angelis D, Welton NJ, Macleod J, Soldan K, Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. Am J Epidemiol. 2013;178:484–92. DOIPubMedGoogle Scholar
- Quinn TC, Gaydos C, Shepherd M, Bobo L, Hook EW, Viscidi R, Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA. 1996;276:1737–42. DOIPubMedGoogle Scholar
- Garnett GP, Mertz KJ, Finelli L, Levine WC, St. Louis ME. The transmission dynamics of gonorrhoea: modelling the reported behaviour of infected patients from Newark, New Jersey. Philos Trans R Soc Lond B Biol Sci. 1999;354:787–97. DOIPubMedGoogle Scholar
- Van Der Pol B, Liesenfeld O, Williams JA, Taylor SN, Lillis RA, Body BA, Performance of the cobas CT/NG test compared to the Aptima AC2 and Viper CTQ/GCQ assays for detection of Chlamydia trachomatis and Neisseria gonorrhoeae. J Clin Microbiol. 2012;50:2244–9. DOIPubMedGoogle Scholar
- Geisler WM. Management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: evidence reviewed for the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2007;44(Suppl 3):S77–83. DOIPubMedGoogle Scholar
- Owusu-Edusei K Jr, Nguyen HT, Gift TL. Utilization and cost of diagnostic methods for sexually transmitted infection screening among insured American youth, 2008. Sex Transm Dis. 2013;40:354–61 . DOIPubMedGoogle Scholar
- Owusu-Edusei K, Roby TM, Chesson HW, Gift TL. Productivity costs of nonviral sexually transmissible infections among patients who miss work to seek medical care: evidence from claims data. Sex Health. 2013;10:434–7. DOIPubMedGoogle Scholar
- Bureau of Labor Statistics. The editor’s desk. Youth employment and unemployment in July 2010, 2013 [cited 2013 Sep 15]. http://www.bls.gov/opub/ted/2010/ted_20100903.htm
- Blandford JM, Gift TL. Productivity losses attributable to untreated chlamydial infection and associated pelvic inflammatory disease in reproductive-aged women. Sex Transm Dis. 2006;33(Suppl):S117–21. DOIPubMedGoogle Scholar
- Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. J Infect Dis. 2013;208:385–93. DOIPubMedGoogle Scholar
- Institute of Medicine. Vaccines for the 21st century: a tool for decisionmaking. Washington (DC): National Academy of Sciences; 2000.
- United States Department of Labor. Consumer price indexes—all urban consumers. 2011 [cited 2013 Dec 15]. http://www.bls.gov/cpi/home.htm
- Blower SM, Dowlatabadi H. Sensitivity and uncertainty analysis of complex models of disease transmission: an HIV model as an example. Int Stat Rev. 1994;62:229–43. DOIGoogle Scholar
- Chen MI, Ghani AC, Edmunds WJ. A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations. J R Soc Interface. 2009;6:775–91 . DOIPubMedGoogle Scholar
- Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8:165–78.
- Gray RT, Beagley KW, Timms P, Wilson DP. Modeling the impact of potential vaccines on epidemics of sexually transmitted Chlamydia trachomatis infection. J Infect Dis. 2009;199:1680–8. DOIPubMedGoogle Scholar
- Hu D, Hook EW III, Goldie SJ. Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis. Ann Intern Med. 2004;141:501–13. DOIPubMedGoogle Scholar
- National Commission for Quality Assurance. Improving quality and patient experience: the state of health care quality. Washington (DC): The Commission; 2013.
- Heijne JCM, Tao GY, Kent CK, Low N. Uptake of regular Chlamydia testing by US women: a longitudinal study. Am J Prev Med. 2010;39:243–50. DOIPubMedGoogle Scholar
- Finer LB, Philbin JM. Sexual initiation, contraceptive use, and pregnancy among young adolescents. Pediatrics. 2013;131:886–91. DOIPubMedGoogle Scholar
- Althaus CL, Heijne JC, Roellin A, Low N. Transmission dynamics of Chlamydia trachomatis affect the impact of screening programmes. Epidemics. 2010;2:123–31.
- Low N, Heijne JC, Kretzschmar M. Use of mathematical modeling to inform Chlamydia screening policy decisions. J Infect Dis. 2009;199:767–8. DOIPubMedGoogle Scholar
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