A cost-effectiveness analysis of the Chlamydia Monday--a community-based intervention to decrease the prevalence of chlamydia in Sweden.

AIMS: The study was undertaken to assess the cost-effectiveness of the Chlamydia Monday, 2007. This is a community-based intervention aimed at reducing the prevalence of chlamydia by information and increased availability of testing, treatment and contact tracing in Stockholm. The aim was to analyze the cost-effectiveness by estimating costs, savings and effects on health associated with the intervention, and to determine if cost-effectiveness varies between men and women. METHODS: A societal perspective was adopted, meaning all significant costs and consequences were taken into consideration, regardless of who experienced them. A cost-effectiveness model was constructed including costs of the intervention, savings due to avoiding potential costs associated with medical sequels of chlamydia infection, and health gains measured as quality adjusted life years (QALY). Sensitivity analyses were done to explore model and result uncertainty. RESULTS: Total costs were calculated to be 66,787.21; total savings to 30,370.14; and total health gains to 9.852324 QALYs (undiscounted figures). The discounted cost per QALY was 8,346.05 (10,810.77/QALY for women and 6,085.35/QALY for men). Sensitivity analyses included changes in effectiveness, variation of prevalence, reduced risk of sequel progression, inclusion of prevented future production loss and shortened duration for chronic conditions. The cost per QALY was consistently less than 50,000, which is often regarded as cost-effective in a Swedish context. CONCLUSIONS: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society's resources.

A cost-effectiveness analysis of alcohol prevention targeting licensed premises.

BACKGROUND: A multi-component alcohol prevention programme targeting licensed premises has been ongoing in Stockholm since 1996. An earlier study has established that this led to a 29% reduction in police-reported violence. The objective of the present study is to calculate the programme's cost-effectiveness from a societal perspective; the cost of implementation, the savings made as a result of fewer assaults, unlawful threats and violence towards officials, and the health gains in terms of quality-adjusted life-years (QALYs). METHODS: The costs included administration, studies of alcohol serving practices, community mobilization, responsible beverage service training and stricter alcohol law enforcement. For the purpose of estimating how the decrease in violence affected savings and health gains, a survey among victims of violence (N=604) was performed. RESULTS: The cost of the programme was estimated at Euro 796,000. The average cost of a violent crime was estimated at Euro 19,049, which implies overall savings of Euro 31.314 million related to the judicial system (78%), production losses (15%), health care issues (5%) and other damages (2%). Accordingly, the base case cost-saving ratio was 1:39. The average loss of health state weighting among the victims at 0.09 translates into 236 gained QALYs for society as a whole, which should be compared with the modest proportion of savings in the health sector. CONCLUSION: The most significant concern is the low response rate (35%), and caution needs to be exercised when interpreting our results. Yet, a reasonable conclusion is that the monetary and human benefits have been considerable.