Sexually transmitted infections (STIs) can cause ill-health and life-long disabilities including infertility. Previous research has highlighted limitations in the evidence base. This thesis aimed to identify and develop approaches for understanding the costs and outcomes of STI control programmes to inform local decision-making in England.

A systematic review assessed economic evaluations of STI control programmes which demonstrated wide heterogeneity in approaches evaluating costs and outcomes. Interviews with sexual health decision-makers showed that considerations of broader outcomes for economic evaluations were often overshadowed by immediate budget pressures. Including costs relevant to local areas was identified as important. Interviews with academic health economists and public health researchers highlighted challenges and provided recommendations particularly around the need to understand decision-makers’ objectives when developing economic evidence. An early costing model was developed to illustrate the costs associated with three care pathways for STI screening. The model demonstrated the complexity of current care pathways and highlighted that accessing services online bears the lowest cost but also the lowest net monetary benefit. The research developed key recommendations in relation to a range of methods to examine the value of sexual health interventions to inform future research in this area.