Impact and cost-effectiveness of XXXX testing in Scotland: a mathematical modelling study.

@entity1 @entity249 @entity2348 @entity4134 @entity1047
BACKGROUND: Chlamydia is the most common sexually transmitted @entity2348 in Scotland, and is associated with potentially serious reproductive outcomes, including @entity4134 ( @entity4134 ) and @entity249 ( @entity249 ) in @entity1 . Chlamydia testing in Scotland is currently targeted towards symptomatic individuals, individuals at high risk of existing undetected infection, and young @entity1 . The cost-effectiveness of testing and treatment to prevent @entity4134 and @entity249 in Scotland is uncertain. METHODS: A compartmental deterministic dynamic model of @entity1047 in 15-24 year olds in Scotland was developed. The model was used to estimate the impact of a change in testing strategy from baseline (16.8% overall testing coverage; 0.4 partners notified and tested/treated per treated positive index) on @entity4134 and @entity249 cases. Cost-effectiveness calculations informed by best-available estimates of the quality-adjusted life years (QALYs) lost due to @entity4134 and @entity249 were also performed. RESULTS: Increasing overall testing coverage by 50% from baseline to 25.2% is estimated to result in 21% fewer cases in young @entity1 each year ( @entity4134 : 703 fewer; @entity249 : 88 fewer). A 50% decrease to 8.4% would result in 20% more @entity4134 (669 additional) and @entity249 (84 additional) cases occurring annually. The cost per QALY gained of current testing activities compared to no testing is   40,034, which is above the   20,000-  30,000 cost-effectiveness threshold. However, calculations are hampered by lack of reliable data. Any increase in partner notification from baseline would be cost-effective (incremental cost per QALY gained for a partner notification efficacy of 1 compared to baseline:   5,119), and would increase the cost-effectiveness of current testing strategy compared to no testing, with threshold cost-effectiveness reached at a partner notification efficacy of 1.5. However, there is uncertainty in the extent to which partner notification is currently done, and hence the amount by which it could potentially be increased. CONCLUSIONS: Current @entity1047 testing strategy in Scotland is not cost-effective under the conservative model assumptions applied. However, with better data enabling some of these assumptions to be relaxed, current coverage could be cost-effective. Meanwhile, increasing partner notification efficacy on its own would be a cost-effective way of preventing @entity4134 and @entity249 from current strategy.
