Could home sexually transmitted infection specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care
Department of Pediatrics, Division of Adolescent Medicine
Bacterial Infections and Mycoses | Female Urogenital Diseases and Pregnancy Complications | Health Services Administration | Infectious Disease | Male Urogenital Diseases | Pediatrics
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.
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Citation: Sex Transm Dis. 2015 Jan;42(1):13-9. doi: 10.1097/OLQ.0000000000000221. Link to article on publisher's site
Blake, Diane R.; Spielberg, Freya; Levy, Vivian; Lensing, Shelly; Wolff, Peter A.; Venkatasubramanian, Lalitha; Acevedo, Nincoshka; Padian, Nancy; Chattopadhyay, Ishita; and Gaydos, Charlotte A., "Could home sexually transmitted infection specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care" (2015). Pediatric Publications and Presentations. 38.