What do we want to know?
Since 2013, health commissioners in England’s local authorities have been responsible for sexual health services. Effective commissioning requires information about which interventions may (or may not) be cost-effective. We systematically reviewed the published evidence from 2010-2015 available on the cost-effectiveness of interventions relevant to UK local authority-commissioned sexual health services. In consultation with our Advisory Group of researchers, public advocacy group representatives, commissioners and policy-makers we focused on the cost-effectiveness of UK-based studies, and of contraception and health promotion interventions.
Who wants to know?
This review was commissioned by the Department of Health’s Sexual Health policy team, in order to support program commissioning decisions taken by local authorities. Findings will be of interest to local commissioners, sexual health practitioners and managers, advocacy groups and researchers.
What did we find?
Of the 29 studies included, nine were conducted in the UK; the remainder were US-based. Overall, studies were of medium methodological quality. In general, there has been a reasonable amount of economic research into sexual health interventions since 2010, and these support current National Institute of Health and Care Excellence (NICE) sexual health guidance. Cost-effectiveness or cost savings were reported 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;
However, none of these reported costs per quality adjusted life year (QALY) within current UK NICE thresholds.
Only three health promotion interventions for HIV or sexually transmitted infection outcomes were found to be cost-effective according to the NICE thresholds:
- 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 reflected the above findings.
What are the 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.
How did we get these results?
A systematic review of economic evaluations of sexual health interventions was undertaken by searching a broad range of sources, screening with specific inclusion and exclusion criteria and data extraction and synthesis using previously developed tools. Each stage was undertaken by two or more researchers. A map of research conducted between 2010 and 2015 was presented to our Advisory Group of various public advocacy groups, researchers and local authority health commissioners; and their perspectives were sought on key interventions to study in more detail. This resulted in a set of 29 included studies which were further synthesised.
This report should be cited as:
Brunton G, Michaels-Igbokwe C, Santos A, Caird J, Siapka M, Teixeira-Filha N, Burchett H, Stokes G, Thomas J (2016) Sexual health promotion and contraceptive services in local authorities: a systematic review of economic evaluations 2010-2015. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.