EXCESS HEALTHCARE RESOURCE UTILISATION AND DIRECT MEDICAL COSTS ASSOCIATED WITH POTENTIALCHLAMYDIA TRACHOMATIS-RELATED SEQUELAE IN GERMANY: A REAL-WORLD EVIDENCE STUDY COVERING 2010 TO 2022
Author(s)
Fabian P. Alvarez, PhD1, Oliver Damm, DrPH2, Valérie Bosch Castells, PhD1, Kylie A. Braegelmann, PhD3, Daniel Gensorowsky, PhD3, Bastian Surmann, M.Sc.3, Sandra S. Chaves, PhD1, Julian Witte, PhD3, Sven Schellberg, PHD4.
1Sanofi, Lyon, France, 2Sanofi-Aventis Deutschland GmbH, Berlin, Germany, 3VANDAGE, Bielefeld, Germany, 4Novopraxis Berlin GbR, Berlin, Germany.
1Sanofi, Lyon, France, 2Sanofi-Aventis Deutschland GmbH, Berlin, Germany, 3VANDAGE, Bielefeld, Germany, 4Novopraxis Berlin GbR, Berlin, Germany.
OBJECTIVES: Chlamydia trachomatis (CT) is the most prevalent bacterial sexually transmitted infection (STI) in Europe. As CT is frequently asymptomatic and undercoded in claims data, infection-centered analyses underestimate its downstream burden. We employed a sequelae-based framework to quantify excess healthcare resource utilization (HCRU) and direct medical costs of potentially CT-associated conditions in Germany.
METHODS: Using statutory health insurance claims data, we conducted a retrospective matched-cohort study in individuals aged 14-44 years across seven sequelae cohorts: pelvic inflammatory disease (PID), ectopic pregnancy, and tubal factor infertility (TFI) in females; epididymo-orchitis, prostatitis, proctitis, and infertility in males. Each case was matched 1:1 to a sequelae-free control on age, sex, region, calendar time, comorbidity, baseline costs, and prior STI testing/diagnosis. HCRU and costs were estimated over 1- and 5-year follow-up from the index sequelae diagnosis using the Zhao-Tian censoring-adjusted estimator; adjusted rate ratios (RR) and incremental costs from regression models.
RESULTS: Across 420,714 matched case-control pairs, all sequelae were associated with significantly elevated HCRU/costs. Within the first year, adjusted hospitalisation RR ranged from 1.35 (male infertility) to 4.95 (ectopic pregnancy); physician contact RR from 1.38 (PID) to 1.74 (TFI), corresponding to +5.1 and +10.9 excess contacts per person-year. Incremental total costs within 1 year were highest for ectopic pregnancy (€2,829; 95%CI:2,769-2,901), TFI (€2,211; 95%CI:2,110-2,350), and proctitis (€1,847; 95%CI:1,704-1,993). Inpatient care was the primary cost driver in female cohorts (37-71% of incremental costs); outpatient costs dominated in prostatitis and male infertility. Burden persisted over 5 years: cumulative excess costs reached €4,902 (proctitis), €3,778 (ectopic pregnancy), and €3,675 (TFI).
CONCLUSIONS: Chlamydia-related sequelae might impose a substantial healthcare burden in Germany. The magnitude of these effects underscores that the extent of CT-associated economic burden lies in its sequelae rather than the acute infection, reinforcing prevention needs.
METHODS: Using statutory health insurance claims data, we conducted a retrospective matched-cohort study in individuals aged 14-44 years across seven sequelae cohorts: pelvic inflammatory disease (PID), ectopic pregnancy, and tubal factor infertility (TFI) in females; epididymo-orchitis, prostatitis, proctitis, and infertility in males. Each case was matched 1:1 to a sequelae-free control on age, sex, region, calendar time, comorbidity, baseline costs, and prior STI testing/diagnosis. HCRU and costs were estimated over 1- and 5-year follow-up from the index sequelae diagnosis using the Zhao-Tian censoring-adjusted estimator; adjusted rate ratios (RR) and incremental costs from regression models.
RESULTS: Across 420,714 matched case-control pairs, all sequelae were associated with significantly elevated HCRU/costs. Within the first year, adjusted hospitalisation RR ranged from 1.35 (male infertility) to 4.95 (ectopic pregnancy); physician contact RR from 1.38 (PID) to 1.74 (TFI), corresponding to +5.1 and +10.9 excess contacts per person-year. Incremental total costs within 1 year were highest for ectopic pregnancy (€2,829; 95%CI:2,769-2,901), TFI (€2,211; 95%CI:2,110-2,350), and proctitis (€1,847; 95%CI:1,704-1,993). Inpatient care was the primary cost driver in female cohorts (37-71% of incremental costs); outpatient costs dominated in prostatitis and male infertility. Burden persisted over 5 years: cumulative excess costs reached €4,902 (proctitis), €3,778 (ectopic pregnancy), and €3,675 (TFI).
CONCLUSIONS: Chlamydia-related sequelae might impose a substantial healthcare burden in Germany. The magnitude of these effects underscores that the extent of CT-associated economic burden lies in its sequelae rather than the acute infection, reinforcing prevention needs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH248
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Disease
Infectious Disease (non-vaccine), Reproductive & Sexual Health, Vaccines