Economic evaluation of the cost of different methods of retesting chlamydia positive individuals in England.

OBJECTIVES: The National Chlamydia Screening Programme (NCSP) in England opportunistically screens eligible individuals for chlamydia infection. Retesting is recommended three3 months after treatment following a positive test result, but no guidance is given on how local areas should recall individuals for retesting. Here , we compare cost estimates for different recall methods to inform the optimal delivery of retesting programmes. DESIGN: Economic evaluation. SETTING: England. METHODS: We estimated the cost of chlamydia retesting for each of the six most commonly used recall methods in 2014 based on existing cost estimates of a chlamydia screen. Proportions accepting retesting, opting for retesting by post, returning postal testing kits and retesting positive were informed by 2014 NCSP audit data. Health professionals 'sense-checked' the costs. PRIMARY AND SECONDARY OUTCOMES: Cost and adjusted cost per chlamydia retest; cost and adjusted cost per chlamydia retest positive. RESULTS: We estimated the cost of the chlamydia retest pathway, including treatment/follow-up call, to be between £45 and £70 per completed test. At the lower end, this compared favourably to the cost of a clinic-based screen. Cost per retest positive was £389-£607. After adjusting for incomplete uptake, and non-return of postal kits, the cost rose to £109-£289 per completed test (cost per retest positive: £946-£2,506). The most economical method in terms of adjusted cost per retest was no active recall as gains in retest rates with active recall did not outweigh the higher cost. Nurse-led client contact by phone was particularly uneconomical, as was sending out postal testing kits automatically. CONCLUSIONS: Retesting without active recall is more economical than more intensive methods such as recalling by phone and automatically sending out postal kits. If sending a short message service (SMS) could be automated, this could be the most economical way of delivering retesting. However, patient choice and local accessibility of services should be taken into consideration in planning.

Evaluation of the impact of a smoke-free home initiative in Rotherham, a deprived district in Northern England.

BACKGROUND: An evaluation of a smoke-free home initiative launched in Rotherham, northern England, in July 2009. METHODS: Two approaches were used: (i) a postal survey of participants 4 months after signing up as a SFH and (ii) a telephone consultation. The survey was sent to 620 households (of 654 who signed up to the scheme); 289 (46.6%) were returned. The telephone consultation involved 20 households before and 20 after signing up to the scheme. RESULTS: Of the households that permitted some smoking at home before the initiative, ~78% became smoke free after signing up (uncertainty due to missing replies). A high number of participants (169, 60.8%) were already informally smoke free. The most common reasons for participation concerned health, environment, and fire safety. Participants were motivated by, amongst other things, information given in a booklet and by the offer of a fire-safety referral. The most immediate benefits noted by participants were improvements in house hygiene. The most important hindrance to success seemed to be a lack of power to enforce the ban at home, particularly on the part of those living in smokers' homes. CONCLUSION: The Rotherham initiative succeeded in creating smoke-free homes. The results should help those planning similar initiatives. Important points include that: many participants had already instituted some rules regarding smoking at home; whether and how to include households that are already smoke-free; risk of fire and concern with house hygiene are important motivations; those living in smokers' homes may lack power to initiate smoke-free rules.