Chlamydia sequelae cost estimates used in current economic evaluations: does one-size-fit-all?

BACKGROUND: Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark). METHODS: From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values. RESULTS: Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412. CONCLUSIONS: There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.

Healthcare Costs Associated with Hydrophilic-Coated And Non-Coated Urinary Catheters for Intermittent Use In the United States.

This health economic evaluation simulated a cohort to compare hydrophilic-coated to non-coated catheters for intermittent catheterization. By using a Markov model, lifetime costs and catheter-related complications were investigated. Results determined that the use of hydrophilic-coated catheters save money and reduce treatment-related complications.

The direct medical cost of epididymitis and orchitis: evidence from a study of insurance claims.

BACKGROUND: Epididymitis and orchitis (EO) are the primary sequelae of acute chlamydia and gonorrhea in men. Existing estimates of the cost per episode of epididymitis are over 10 years old or are based on limited data. OBJECTIVE: The objective of this study was to estimate direct medical costs of EO from insurance claims data. STUDY DESIGN: We used 1998 and 1999 insurance claims taken from a national database. We used International Classification of Diseases, 9th Revision codes to identify inpatient and outpatient claims for EO treatment. Prescription drug claims were identified with National Drug Codes. To capture episodes of EO that were most likely sequelae of sexually transmitted diseases, we categorized claims based on age at the time of the initial EO claim. RESULTS: The total cost per episode was US dollars 368 for males <13 years of age, US dollars 242 for those > or =13 and <41 years of age, and US dollars 291 for those > or =41 years of age. The cost for both younger and older men was significantly different from men > or =13 and <41 years of age. Inpatient claims were relatively rare, occurring in < or =1.2% of total episodes. CONCLUSION: The cost per episode we calculated was lower than previously published estimates and can be attributed to a lower rate of inpatient care than previously observed or estimated.

Evaluation of acute scrotum in the emergency department.

A 2-year retrospective review of 238 cases of acute scrotal pain encountered in a children's hospital emergency department is presented. The incidences of testicular torsion, torsion of a testicular appendage, and epididymitis were 16%, 46%, and 35%, respectively. Testicular salvage was critically dependent on the interval between onset of pain and surgical intervention. No testis likely to have been viable at the time of presentation was "lost." The diagnostic error rate on first encounter was 7%, resulting in 10 negative scrotal explorations. With the exception of cases of far-advanced necrotic testes, both color Doppler ultrasound and radioisotope imaging were highly specific diagnostic modalities. Thirty-nine percent of the children with epididymitis who underwent investigation were found to have either structural or functional urinary tract abnormalities. Noninvasive urodynamic studies appear to be useful screening modalities in older children with epididymitis.

[The assessment of the efficacy of introducing a new method for treating gonorrhea]. / Ob otsenke éffektivnosti vnedreniia novogo metoda lecheniia gonorei.

Proteolytic enzymes (chymotrypsin, trypsin) i.m. injections in a dose of 5 mg twice daily for 4 to 10 days were used in combined therapy of 218 patients with recurrences of gonorrhea, gonorrheal epididymitis and orchiepididymitis; 23 patients with acute orchiepididymitis were injected heparin intramuscularly in a dose of 5000 U twice daily for 7 weeks. Etiologic cure was achieved in 99.7 percent, postgonorrheal residual phenomena were detected in 5.7 percent of cases (93.9 and 17.5 percent, respectively, in a reference group). The length of treatment of a patient with gonorrhea relapse shortened by 8.6 days on an average and of that with orchiepididymitis and epididymitis by 5.9 days. Formula are presented for calculating the economic efficacy of treatment of those working and not working patients.

Chlamydia trachomatis infections in the United States. What are they costing us?

Chlamydia trachomatis has emerged as the most common sexually transmitted bacterial pathogen in the United States and is now recognized to cause substantial morbidity. To determine the economic consequences of chlamydial infections in the United States, we analyzed data from local, state, and national sources. We estimate that C trachomatis infections cost Americans over $1.4 billion per year in direct and indirect costs. Chlamydial infections in women account for 79% of this cost, although men and infants are also affected. Three fourths of the total cost is due to sequelae of untreated, uncomplicated infections. If the current rate of chlamydial infection persists, the projected annual costs will exceed $2.18 billion by 1990. Reducing the incidence of personal suffering and heavy economic burden imposed by C trachomatis infections requires establishment and maintenance of effective prevention/control programs.