Could Home Sexually Transmitted Infection Specimen Collection With e-Prescription Be a Cost-Effective Strategy for Clinical Trials and Clinical Care?. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Blake, Diane R.; Spielberg, Freya; Levy, Vivian; Lensing, Shelly; Wolff, Peter A.; Venkatasubramanian, Lalitha; Acevedo, Nincoshka; Padian, Nancy; Chattopadhyay, Ishita; Gaydos, Charlotte A.
• Is Part Of: Sexually transmitted diseases. Volume 42:Issue 1(2015)
• Publication Date: 2015-01
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000000221
• Languages: English
• ISSNs: 0148-5717

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>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.</p> </sec> <sec> <title>Methods</title> <p>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.</p> </sec> <sec> <title>Results</title> <p>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.</p> </sec> <sec> <title>Conclusions</title> <p>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.</p> </sec> </abstract>