Chlamydia screening is not cost-effective at low participation rates: evidence from a repeated register-based implementation study in The Netherlands

G Ardine de Wit, Eelco A B Over, Boris V Schmid, Jan E A M van Bergen, Ingrid V F van den Broek, Marianne A B van der Sande, Robert Welte, Eline L M Op de Coul, Mirjam E Kretzschmar

Research output: Contribution to journalA1: Web of Science-articlepeer-review


OBJECTIVE: In three pilot regions of The Netherlands, all 16-29 year olds were invited to participate in three annual rounds of Chlamydia screening. The aim of the present study is to evaluate the cost-effectiveness of repeated Chlamydia screening, based on empirical data.

METHODS: A mathematical model was employed to estimate the influence of repeated screening on prevalence and incidence of Chlamydial infection. A model simulating the natural history of Chlamydia was combined with cost and utility data to estimate the number of major outcomes and quality-adjusted life-years (QALYs) associated with Chlamydia. Six screening scenarios (16-29 years annually; 16-24 years annually; women only; biennial screening; biennial screening women only; screening every five years) were compared with no screening in two sexual networks, representing both lower ('national network') and higher ('urban network') baseline prevalence. Incremental cost-effectiveness ratios (ICERs) for the different screening scenarios were estimated. Uncertainty and sensitivity analyses were performed.

RESULTS: In all scenarios and networks, cost per major outcome averted are above €5000. Cost per QALY are at least €50,000. The default scenario as piloted in the Netherlands was least cost-effective, with ICERs of €232,000 in the national and €145,000 in the urban sexual network. Results were robust in sensitivity analyses.

CONCLUSIONS: It is unlikely that repeated rounds of Chlamydia screening will be cost-effective. Only at high levels of willingness to pay for a QALY (>€50,000) screening may be more cost-effective than no screening.

Original languageEnglish
JournalSexually Transmitted Infections
Issue number6
Pages (from-to)423-429
Number of pages7
Publication statusPublished - 2015


  • Adolescent
  • Adult
  • Chlamydia Infections/diagnosis
  • Chlamydia trachomatis/isolation & purification
  • Cost-Benefit Analysis
  • Evidence-Based Medicine
  • Female
  • Humans
  • Incidence
  • Male
  • Mass Screening/economics
  • Models, Theoretical
  • Netherlands/epidemiology
  • Patient Participation/statistics & numerical data
  • Pilot Projects
  • Registries


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