Brunton, G; Michaels-Igbokwe, C; Santos, A; Caird, J; Siapka, M; Teixeira-Filha, N; Burchett, H; + view all Brunton, G; Michaels-Igbokwe, C; Santos, A; Caird, J; Siapka, M; Teixeira-Filha, N; Burchett, H; Stokes, G; Thomas, J; - view fewer (2016) Sexual health promotion and contraceptive services in local authorities: a systematic review of economic evaluations 2010-2015. EPPI-Centre, Social Science Research Unit, UCL Institute of Education: London, UK.

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Abstract

Background Since 2013, health commissioners in England’s local authorities have been responsible for sexual health services, including contraception, HIV testing, STI testing and treatment, health education and specialist sexual health services. Effective commissioning requires information to indicate which interventions may, or may not, be cost-effective. However, current UK guidance and recent research on the cost-effectiveness of sexual health services provides patchy and fragmented evidence. This study aims systematically to review the evidence available on the cost-effectiveness of OECD-based interventions relevant to UK local authority-commissioned sexual health services. Methods Key informants, bibliographic database searches and reference lists of guidance documents and included studies were searched for potentially relevant research. Guided by key stakeholders, we sought economic evaluations of sexual health interventions within the responsibility of local authorities, and focused in the UK, on contraception and on health promotion, published between 2010 and 2015 in English. Eligible studies were full economic evaluations based in an OECD country. Studies were classified using a specifically developed tool and assessed for methodological risk of bias using one of three design-specific assessment tools. Descriptive frequencies of codes were analysed to provide a ‘map’ of research that informed stakeholder discussions to focus the subsequent synthesis. The characteristics of studies, quality ratings and cost outcomes from each included study were extracted into tables and findings summarised narratively. Studies were assessed for their relative cost-saving or cost-effectiveness according to NICE guidance. Results In total, 17,705 references were screened; of these, 29 met our inclusion criteria and were included in the synthesis. Nine studies were undertaken in the UK; the remainder were US based. Fifteen studies examined the economics of contraception and 14 evaluated health promotion. Overall, studies were of medium methodological quality. In general, economic evaluations of contraception reported cost-effectiveness or cost savings for ulipristal acetate (UPA) as emergency contraception, long-acting reversible contraceptives (LARCs) for regular, post-natal and post-abortion contraception, and targeting to high risk groups; none, however, reported costs per quality-adjusted life year (QALY) within NICE thresholds. Economic evaluations of sexual health promotion interventions indicated more mixed results. Only three interventions were found to be cost-effective according to the NICE thresholds for HIV or sexually transmitted infection (STI) outcomes: nurse-led rapid testing and tailored counselling; condom negotiations skills training for female sex workers; and a teacher-led STI prevention and skills training intervention. UK studies focused on health promotion and contraception, and supported the above findings. In general, there has been a reasonable amount of economic research into sexual health interventions since 2010, and these support current NICE sexual health guidance. Abstract Sexual health promotion and contraceptive services in local authorities: a systematic review of economic evaluations 2010-2015 vi Conclusions The broad nature of the research question posed in this systematic review resulted in the inclusion of a dataset very diverse in terms of populations, interventions, outcomes and types of economic evaluation designs. In considering the cost-effectiveness of these strategies in relation to their own commissioning climate, policy and decision makers should consider carefully the fit between their context and that of individual studies. Use of longer-term outcomes in trials used in economic evaluations would strengthen estimates of effects such as QALYs, as would the routine use of longitudinal cohort data.

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