Could Home Sexually Transmitted Infection Specimen Collection With e-Prescription Be a Cost-Effective Strategy for Clinical Trials and Clinical Care?

Abstract

Background Results of a recent demonstration project evaluating feasibility, acceptability, and cost of a web-based 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 healthcare system perspective. Results The eSTI strategy detected 75 infections, and the Clinic-referral strategy detected 45 infections. Total cost of eSTI was $94,938 ($1,266/STI detected) from the clinical trial perspective and $96,088 ($1,281/STI detected) from the healthcare system perspective. Total cost of clinic referral was $87,367 ($1,941/STI detected) from the clinical trial perspective and $71,668 ($1,593/STI detected) from the healthcare 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 (CER) 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.

Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis

“…If both uptake and case finding increase, expansion of STI services through sample self-collection may be cost-effective, though more research on this is warranted. Several studies have suggested that internet-based screening or other models using self-collection of samples for STI testing may be cost-effective compared with clinician-collected samples 27 54. Self-collection as an additional approach to STI testing and diagnosis supports the WHO global health sector strategy on STIs, which emphasises the need for identifying targeted accessible interventions, which ensure that people use the quality health services they need without suffering financial hardship or stigmatisation 53.…”

“…Because this study was designed to inform WHO guidelines on the viability of self-sampling as an additional means to increase testing, articles that compared self-collection of samples by the location of intervention delivery (ie, self-collection at home vs self-collection at the clinic) were not included. These articles have been reviewed elsewhere 19 26–31…”

“…Self-collection approaches also have the potential to address some common barriers to clinician-dependent and/or clinic-based diagnosis, such as concerns around autonomy, inconvenience, stigma and lack of privacy 5 24 25. Systematic reviews have been conducted to compare STI testing programmes (some including self-collection methods) in home or non-clinic settings to those in clinic settings 19 26–31. However, no review to date has systematically compared self-collection of samples to clinician-collected methods for STI testing on programmatic outcomes.…”

Sexually Transmitted Infections Among Young Men Who Have Sex with Men: Experiences with Diagnosis, Treatment, and Reinfection

“…Although this is a valid frustration, it is important for YMSM to understand the potential health consequences of untreated STIs. Given evidence of the feasibility and acceptability of home-based STI testing and treatment (Blake et al, 2015), future research could explore options to expedite treatment in the context of an eHealth study for YMSM.…”

Self care interventions for sexual and reproductive health and rights: costs, benefits, and financing

“…For example, the use of self samples to test for sexually transmitted infections among women in the US was more costly than clinic testing but also more effective at detecting infections (chlamydia, gonorrhoea, trichomonas), making the cost per diagnosis potentially lower. 17 Modelling showed that after screening validity and medical costs averted were taken into account, self sampling was less costly and clinically superior to clinic based sampling for chlamydia. 18 …”