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Sex Transm Dis. 2015 Jan;42(1):13-9. doi: 10.1097/OLQ.0000000000000221.

Could home sexually transmitted infection specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care?

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From the *Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA; †Department of Prevention and Community Health, George Washington University School of Public Health, Washington, DC; ‡San Mateo County Health System, San Mateo, CA; §Division of Infectious Diseases, Stanford University, Stanford, CA; ¶Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; ∥National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; **FHI360, Durham, NC; ††Division of Epidemiology, University of California, Berkeley, CA; and ‡‡Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD.



Results of a recent demonstration project evaluating feasibility, acceptability, and cost of a Web-based sexually transmitted infection (STI) testing and e-prescription treatment program (eSTI) suggest that this approach could be a feasible alternative to clinic-based testing and treatment, but the results need to be confirmed by a randomized comparative effectiveness trial.


We modeled a decision tree comparing (1) cost of eSTI screening using a home collection kit and an e-prescription for uncomplicated treatment versus (2) hypothetical costs derived from the literature for referral to standard clinic-based STI screening and treatment. Primary outcome was number of STIs detected. Analyses were conducted from the clinical trial perspective and the health care system perspective.


The eSTI strategy detected 75 infections, and the clinic referral strategy detected 45 infections. Total cost of eSTI was $94,938 ($1266/STI detected) from the clinical trial perspective and $96,088 ($1281/STI detected) from the health care system perspective. Total cost of clinic referral was $87,367 ($1941/STI detected) from the clinical trial perspective and $71,668 ($1593/STI detected) from the health care system perspective.


Results indicate that eSTI will likely be more cost-effective (lower cost/STI detected) than clinic-based STI screening, both in the context of clinical trials and in routine clinical care. Although our results are promising, they are based on a demonstration project and estimates from other small studies. A comparative effectiveness research trial is needed to determine actual cost and impact of the eSTI system on identification and treatment of new infections and prevention of their sequelae.

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