Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling
Background: Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2014-01-01
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| Series: | Health Technology Assessment |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/hta18020 |
| _version_ | 1818142070962913280 |
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| author | Christian L Althaus Katherine ME Turner Catherine H Mercer Peter Auguste Tracy E Roberts Gill Bell Sereina A Herzog Jackie A Cassell W John Edmunds Peter J White Helen Ward Nicola Low |
| author_facet | Christian L Althaus Katherine ME Turner Catherine H Mercer Peter Auguste Tracy E Roberts Gill Bell Sereina A Herzog Jackie A Cassell W John Edmunds Peter J White Helen Ward Nicola Low |
| author_sort | Christian L Althaus |
| collection | DOAJ |
| description | Background: Partner notification is essential to the comprehensive case management of
sexually transmitted infections. Systematic reviews and mathematical
modelling can be used to synthesise information about the effects of new
interventions to enhance the outcomes of partner notification. Objective: To study the effectiveness and cost-effectiveness of traditional and new
partner notification technologies for curable sexually transmitted
infections (STIs). Design: Secondary data analysis of clinical audit data; systematic reviews of
randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register
of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of
studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web
of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of
Abstracts of Reviews of Effects (DARE) and Health Technology Assessment
(HTA)] published from 1 January 1980 to 31 December 2011; static models of
clinical effectiveness and cost-effectiveness; and dynamic modelling studies
to improve parameter estimation and examine effectiveness. Setting: General population and genitourinary medicine clinic attenders. Participants: Heterosexual women and men. Interventions: Traditional partner notification by patient or provider referral, and new
partner notification by expedited partner therapy (EPT) or its UK
equivalent, accelerated partner therapy (APT). Main outcome measures: Population prevalence; index case reinfection; and partners treated per index
case. Results: Enhanced partner therapy reduced reinfection in index cases with curable STIs
more than simple patient referral [risk ratio (RR) 0.71; 95% confidence
interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The
median number of partners treated for chlamydia per index case in UK clinics
was 0.60. The number of partners needed to treat to interrupt transmission
of chlamydia was lower for casual than for regular partners. In dynamic
model simulations, > 10% of partners are chlamydia positive
with look-back periods of up to 18 months. In the presence of a chlamydia
screening programme that reduces population prevalence, treatment of current
partners achieves most of the additional reduction in prevalence
attributable to partner notification. Dynamic model simulations show that
cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence
of both STIs. APT has a limited additional effect on prevalence but reduces
the rate of index case reinfection. Published quality-adjusted life-year
(QALY) weights were of insufficient quality to be used in a
cost-effectiveness study of partner notification in this project. Using an
intermediate outcome of cost per infection diagnosed, doubling the efficacy
of partner notification from 0.4 to 0.8 partners treated per index case was
more cost-effective than increasing chlamydia screening coverage. Conclusions: There is evidence to support the improved clinical effectiveness of EPT in
reducing index case reinfection. In a general heterosexual population,
partner notification identifies new infected cases but the impact on
chlamydia prevalence is limited. Partner notification to notify casual
partners might have a greater impact than for regular partners in
genitourinary clinic populations. Recommendations for future research are
(1) to conduct randomised controlled trials using biological outcomes of the
effectiveness of APT and of methods to increase testing for human
immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data
should be a priority to determine QALYs associated with the sequelae of
curable STIs; and (3) standardised parameter sets for curable STIs should be
developed for mathematical models of STI transmission that are used for
policy-making. Funding: The National Institute for Health Research Health Technology Assessment
programme. |
| first_indexed | 2024-12-11T11:09:56Z |
| format | Article |
| id | doaj.art-493403db31db4956938afc46f87d76de |
| institution | Directory Open Access Journal |
| issn | 1366-5278 2046-4924 |
| language | English |
| last_indexed | 2024-12-11T11:09:56Z |
| publishDate | 2014-01-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Health Technology Assessment |
| spelling | doaj.art-493403db31db4956938afc46f87d76de2022-12-22T01:09:34ZengNIHR Journals LibraryHealth Technology Assessment1366-52782046-49242014-01-0118210.3310/hta1802007/42/02Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modellingChristian L Althaus0Katherine ME Turner1Catherine H Mercer2Peter Auguste3Tracy E Roberts4Gill Bell5Sereina A Herzog6Jackie A Cassell7W John Edmunds8Peter J White9Helen Ward10Nicola Low11Institute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandSchool of Social and Community Medicine, University of Bristol, Bristol, UKCentre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, UKHealth Economics Facility, University of Birmingham, Birmingham, UKHealth Economics Facility, University of Birmingham, Birmingham, UKAcademic Directorate of Communicable Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandBrighton and Sussex Medical School, University of Brighton, Brighton, UKInfectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UKModelling and Economics Unit, Health Protection Agency (now Public Health England), London, UKDepartment of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UKInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandBackground: Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. Objective: To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). Design: Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. Setting: General population and genitourinary medicine clinic attenders. Participants: Heterosexual women and men. Interventions: Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). Main outcome measures: Population prevalence; index case reinfection; and partners treated per index case. Results: Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, > 10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. Conclusions: There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. Funding: The National Institute for Health Research Health Technology Assessment programme.https://doi.org/10.3310/hta18020sexually transmitted infectionschlamydiagonorrhoeapartner notificationexpedited partner therapyaccelerated partner therapymathematical modellingeconomic evaluationsystematic reviewclinical audit |
| spellingShingle | Christian L Althaus Katherine ME Turner Catherine H Mercer Peter Auguste Tracy E Roberts Gill Bell Sereina A Herzog Jackie A Cassell W John Edmunds Peter J White Helen Ward Nicola Low Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling Health Technology Assessment sexually transmitted infections chlamydia gonorrhoea partner notification expedited partner therapy accelerated partner therapy mathematical modelling economic evaluation systematic review clinical audit |
| title | Effectiveness and cost-effectiveness of traditional and new partner
notification technologies for curable sexually transmitted infections:
observational study, systematic reviews and mathematical
modelling |
| title_full | Effectiveness and cost-effectiveness of traditional and new partner
notification technologies for curable sexually transmitted infections:
observational study, systematic reviews and mathematical
modelling |
| title_fullStr | Effectiveness and cost-effectiveness of traditional and new partner
notification technologies for curable sexually transmitted infections:
observational study, systematic reviews and mathematical
modelling |
| title_full_unstemmed | Effectiveness and cost-effectiveness of traditional and new partner
notification technologies for curable sexually transmitted infections:
observational study, systematic reviews and mathematical
modelling |
| title_short | Effectiveness and cost-effectiveness of traditional and new partner
notification technologies for curable sexually transmitted infections:
observational study, systematic reviews and mathematical
modelling |
| title_sort | effectiveness and cost effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections observational study systematic reviews and mathematical modelling |
| topic | sexually transmitted infections chlamydia gonorrhoea partner notification expedited partner therapy accelerated partner therapy mathematical modelling economic evaluation systematic review clinical audit |
| url | https://doi.org/10.3310/hta18020 |
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