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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?

Author information

1
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.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
25504295
PMCID:
PMC4276035
DOI:
10.1097/OLQ.0000000000000221
[Indexed for MEDLINE]
Free PMC Article

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