Consequences of restricted STI testing for young heterosexuals in the Netherlands on test costs and QALY losses

• Published in: Health policy (Amsterdam) Vol. 122; no. 2; pp. 198 - 203
• Main Authors: Suijkerbuijk, Anita W.M., Over, Eelco A.B., van Aar, Fleur, Götz, Hannelore M., van Benthem, Birgit H.B., Lugnér, Anna K.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2018; Elsevier Science Ltd
• Subjects: Adult; Chlamydia trachomatis; Clients; Clinics; Cost analysis; Costs; Data analysis; Female; Gonorrhea; Government Programs; Health administration; Health care expenditures; Health care policy; Health education; Health services research; Heterosexuality; HIV; Human immunodeficiency virus; Humans; Immigrants; Infections; Male; Mass Screening - economics; Medical diagnosis; Netherlands; Policy; Quality adjusted life years; Savings; Second generation; Sensitivity analysis; Sexual orientation; Sexually transmitted diseases; Sexually Transmitted Diseases - diagnosis; Sexually Transmitted Diseases - economics; STD; STI testing; Surveillance; Syphilis; Willingness to pay; Policy; Costs; HIV; Syphilis; STI testing; Health services research
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2017.12.001

•Restricted STI testing for young heterosexuals could save a million Euros annually.•The 2015 testing policy would lead to few missed HIV and syphilis infections annually.•Offering second-generation immigrants an HIV and syphilis test could be considered.•In case of a chlamydia or gonorrhoea diagnosis additional tests are indicated. Due to rising costs caused by increasing demand for sexually transmitted infection (STI) care, the Dutch government changed the funding of STI clinics. In 2015, a more restrictive testing policy was introduced with syphilis and HIV tests only on indication for younger, heterosexual clients. We evaluated intended savings and missed syphilis and/or HIV infections and explored efficiency of possible test policies. Using surveillance data from 2011 to 2013 with extensive testing for all, we estimated effects of restrictive testing on test costs, number of infections missed, costs per Quality Adjusted Life Year (QALY) lost, and calculated the net monetary benefit from a government perspective. The 2015 policy led to estimated savings of €1.1 million, while missing approximately three HIV infections and seven syphilis infections annually. Savings were €435,000/QALY lost. If testing second-generation immigrants for syphilis and HIV, savings rose to €525,000/QALY lost. Offering an HIV test when diagnosed with chlamydia or gonorrhoea savings were €568,000/QALY lost. In a sensitivity analysis, the willingness-to-pay threshold had the highest impact on results. The 2015 testing policy resulted in a modest decline of detected HIV and syphilis infections, generating substantial savings. Syphilis and HIV tests for both first- and second-generation immigrants and an HIV test in case of positive chlamydia or gonorrhoea diagnosis could reduce missed infections in a cost-effective way.