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Objectives: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people.

Methods: We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs.

Results: The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.

Conclusions: School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

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1.Adams EJ, Turner KM, Edmunds WJ. The cost effectiveness of opportunistic chlamydia screening in England. Sex Transm Infect. 2007;83:267274.
2.Barham L, Lewis D, Latimer N. One to one interventions to reduce sexually transmitted infections and under the age of 18 conceptions: A systematic review of the economic evaluations. Sex Transm Infect. 2007;83:441446.
3.Brown RE, Breugelmans JG, Theodoratou D, Benard S. Costs of detection and treatment of cervical cancer, cervical dysplasia and genital warts in the UK. Curr Med Res Opin. 2006;22:663670.
4.Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE. Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008;14:244251.
5.Chlamydia Advisory Group. The first steps. . . Annual report of the National Chlamydia Screening Programme in England. London: Department of Health; 2004:144.
6.Cohen DA, Wu SY, Farley TA. Comparing the cost-effectiveness of HIV prevention interventions (DARE structured abstract). J Acquir Immune Defic Syndr. 2004;37:14041414.
7.Curtis L, Netten A. Unit costs of health and social care. Canterbury, PSSRU, University of Kent; 2006.
8.Fisher M, Benn P, Evans B, et al.UK Guideline for the use of post-exposure prophylaxis for HIV following sexual exposure. Int J STD AIDS. 2006;17:8192.
9.Health Protection Agency. Diagnoses and rates of selected STIs seen at UK GUM clinics by country and age group: 2002–2006. London: Health Protection Agency, Centre for Infections; 2007:133.
10.Health Protection Agency. Testing times HIV and other sexually transmitted infections in the United Kingdom. London: Health Protection Agency, Centre for Infections; 2007.
11.Howell-Jones R. Baseline HPV epidemiology studies. 2008 (accessed October 1, 2008).
12.Hu D, Hook EW III, Goldie SJ. Screening for Chlamydia trachomatis in women 15 to 29 years of age: A cost-effectiveness analysis. Ann Intern Med. 2004;141:501513.
13.Johnson AM, Mercer CH, Erens B, et al.Sexual behaviour in Britain: Partnerships, practices, and HIV risk behaviours. Lancet. 2001;358:18351842.
14.Lader D.Contraception and sexual health. Omnibus Survey Report No. 33. -108. Newport: Office of National Statistics; 2007.
15.Langley PC, White DJ, Drake SM. The costs of treating external genital warts in England and Wales: A treatment pattern analysis. Int J STD AIDS. 2004;15:501508.
16.Low N, McCarthy A, Macleod J, et al.Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection. Health Technol Assess. 2007;11:iiixii, 1.
17.Miners AH, Sabin CA, Trueman P, et al.Assessing the cost-effectiveness of HAART for adults with HIV in England. HIV Med. 2001;2:5258.
18.NICE. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence; 2008.
19.Quinn TC, Gaydos C, Shepherd M, et al.Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA. 1996;276:17371742.
20.Rao GG, Bacon L, Evans J, et al.Prevalence of Neisseria gonorrhoeae infection in young subjects attending community clinics in South London. Sex Transm Infect. 2008;84:117121.
21.Rothenberg R, Potterat JJ, Koplan JP. The algebra of condoms and abstinence. Sex Transm Dis. 2005;32:252254.
22.Shepherd J, Kavanagh J, Picot J, et al.The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13–19: A systematic review and economic evaluation. Health Technol Assess. 2010;14:1-iv.
23.Smith KJ, Tsevat J, Ness RB, Wiesenfeld HC, Roberts MS. Quality of life utilities for pelvic inflammatory disease health States. Sex Transm Dis. 2008;35:307311.
24.Stephenson JM, Strange V, Forrest S, et al.Pupil-led sex education in England (RIPPLE study): Cluster-randomised intervention trial. Lancet. 2004;364:338346.
25.Tengs TO, Lin TH. A meta-analysis of utility estimates for HIV/AIDS. [see comment]. Med Decis Making. 2002;22:475481.
26.Wang LY, Davis M, Robin L, et al.Economic evaluation of safer choices: A school-based human immunodeficiency virus, other sexually transmitted diseases, and pregnancy prevention program. Arch Pediatr Adolesc Med. 2000;154:10171024.
27.Weatherly H, Drummond M, Claxton K, et al.Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations. Health Policy. 2009;93:8592.
28.Weinstein M, Graham J, Siegel J. Cost effectiveness analysis of AIDS prevention programs: Concepts, complications, and illustrations. In: Turner C, Miller H, Moses L, eds. AIDS: Sexual behavior and intravenous drug use. Washington, DC: National Academy Press; 1989:471499.
29.WHO. In: Currie C, Gabhainn S, Godeau E, Roberts C, Smith R, eds. Inequalities in young people's health. HBSC international report from the 2005/2006 survey. Copenhagen, Denmark: WHO; 2008:1210.
30.Wight D, Raab GM, Henderson M, et al.Limits of teacher delivered sex education: Interim behavioural outcomes from randomised trial. BMJ. 2002;324:1430.
31.Wolstenholme JL, Whynes DK. Stage-specific treatment costs for cervical cancer in the United Kingdom. Eur J Cancer. 1998;34:18891893.
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