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An economic model of school-based behavioral interventions to prevent sexually transmitted infections.

Cooper K, Shepherd J, Picot J, Jones J, Kavanagh J, Harden A, Barnett-Page E, Clegg A, Hartwell D, Frampton G, Price A - Int J Technol Assess Health Care (2012)

Bottom Line: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy.Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

View Article: PubMed Central - PubMed

Affiliation: Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK. kc@soton.ac.uk

ABSTRACT

Objectives: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people.

Methods: We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs.

Results: The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.

Conclusions: School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

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Related in: MedlinePlus

Cost-effectiveness acceptability curves of the PSA results for 1,000 iterations for the teacher and peer led interventions versus standard care. QALY, quality-adjusted life-year.
© Copyright Policy - open-access
Related In: Results  -  Collection


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fig1: Cost-effectiveness acceptability curves of the PSA results for 1,000 iterations for the teacher and peer led interventions versus standard care. QALY, quality-adjusted life-year.

Mentions: We also explored the uncertainty around the model results in more detail using probabilistic sensitivity analyses. The model was run for 1,000 iterations with input values sampled from probability distributions. The parameters were varied according to the ranges used in the deterministic sensitivity analysis. In this analysis, the teacher-led intervention had an ICER between €0 and €36,000 per QALY for 48 percent of iterations (Figure 1), more than €36,000 per QALY for 28 percent of iterations. For 24 percent of iterations, the intervention was associated with a QALY loss. The peer-led intervention had a corresponding lower likelihood of being cost-effectiveness, with an ICER between €0 and €36,000 per QALY for 16 percent of iterations.Figure 1.


An economic model of school-based behavioral interventions to prevent sexually transmitted infections.

Cooper K, Shepherd J, Picot J, Jones J, Kavanagh J, Harden A, Barnett-Page E, Clegg A, Hartwell D, Frampton G, Price A - Int J Technol Assess Health Care (2012)

Cost-effectiveness acceptability curves of the PSA results for 1,000 iterations for the teacher and peer led interventions versus standard care. QALY, quality-adjusted life-year.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3472553&req=5

fig1: Cost-effectiveness acceptability curves of the PSA results for 1,000 iterations for the teacher and peer led interventions versus standard care. QALY, quality-adjusted life-year.
Mentions: We also explored the uncertainty around the model results in more detail using probabilistic sensitivity analyses. The model was run for 1,000 iterations with input values sampled from probability distributions. The parameters were varied according to the ranges used in the deterministic sensitivity analysis. In this analysis, the teacher-led intervention had an ICER between €0 and €36,000 per QALY for 48 percent of iterations (Figure 1), more than €36,000 per QALY for 28 percent of iterations. For 24 percent of iterations, the intervention was associated with a QALY loss. The peer-led intervention had a corresponding lower likelihood of being cost-effectiveness, with an ICER between €0 and €36,000 per QALY for 16 percent of iterations.Figure 1.

Bottom Line: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy.Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

View Article: PubMed Central - PubMed

Affiliation: Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK. kc@soton.ac.uk

ABSTRACT

Objectives: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people.

Methods: We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs.

Results: The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.

Conclusions: School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

Show MeSH
Related in: MedlinePlus