One-to-One Interventions to Reduce Sexually Transmitted Infections and Under the Age of 18 Conceptions: A Systematic Review of the Economic Evaluations

The authors set out to conduct a systematic review and critical appraisal of the economic evaluations of one-to-one interventions to reduce STDs and teenage pregnancy.

Four electronic bibliographic databases from 1990 to January 2006 were searched using keywords including: teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STDs, including specific disease names. Studies were included that assessed a wide range of one-to-one interventions aimed at reducing STDs. Outcomes included major outcomes averted, life years and quality-adjusted life years (QALY). All studies were assessed against quality criteria.

The researchers identified 3,190 papers, of which 55 were included. Most studies found one-to-one interventions were either cost-saving or cost-effective. One, however, highlighted the need to target the population to receive post-exposure prophylaxis to reduce HIV transmission. Most of the studies employed a static approach that does not consider the potential re-infection of treated patients.

"One-to-one interventions have been shown to be cost-saving or cost-effective, but there are some limitations in applying this evidence to the UK policy context," the authors concluded. "More UK research using dynamic modeling approaches and QALY would provide improved evidence, enabling more robust policy recommendations to be made about which one-to-one interventions are cost-effective in reducing [STDs] in the UK setting. The results of this review can be used by policy makers, health economists, and researchers considering further research in this area."

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