Economic evaluation alongside a clinical trial of near-to-patient testing for sexually transmitted infections

Ying Zhang; Lenka A. Vodstrcil; Kay Htaik; Erica L. Plummer; Vesna De Petra; Melodi G. Sen; Deborah A. Williamson; Monica Owlad; Gerald Murray; Eric PF Chow; Christopher K. Fairley; Catriona S. Bradshaw; Jason J. Ong

Journal of Infection and Public Health (Jul 2024)

Economic evaluation alongside a clinical trial of near-to-patient testing for sexually transmitted infections

Ying Zhang,
Lenka A. Vodstrcil,
Kay Htaik,
Erica L. Plummer,
Vesna De Petra,
Melodi G. Sen,
Deborah A. Williamson,
Monica Owlad,
Gerald Murray,
Eric PF Chow,
Christopher K. Fairley,
Catriona S. Bradshaw,
Jason J. Ong

Affiliations

Ying Zhang: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
Lenka A. Vodstrcil: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
Kay Htaik: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
Erica L. Plummer: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
Vesna De Petra: Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
Melodi G. Sen: Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
Deborah A. Williamson: Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
Monica Owlad: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
Gerald Murray: Murdoch Children’s Research Institute, Parkville, Victoria, Australia; Women’s Centre for Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
Eric PF Chow: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
Christopher K. Fairley: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
Catriona S. Bradshaw: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Corresponding authors at: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Jason J. Ong: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Corresponding authors at: School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.

Journal volume & issue: Vol. 17, no. 7
p. 102447

Abstract

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Background: Current clinical care for common bacterial STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG)) involves empiric antimicrobial therapy when clients are symptomatic, or if asymptomatic, waiting for laboratory testing and recall if indicated. Near-to-patient testing (NPT) can improve pathogen-specific prescribing and reduce unnecessary or inappropriate antibiotic use in treating sexually transmitted infections (STI) by providing same-day delivery of results and treatment. Methods: We compared the economic cost of NPT to current clinic practice for managing clients with suspected proctitis, non-gonococcal urethritis (NGU), or as an STI contact, from a health provider’s perspective. With a microsimulation of 1000 clients, we calculated the cost per client tested and per STI- and pathogen- detected for each testing strategy. Sensitivity analyses were conducted to assess the robustness of the main outcomes. Costs are reported as Australian dollars (2023). Results: In the standard care arm, cost per client tested for proctitis, NGU in men who have sex with men (MSM) and heterosexual men were the highest at $247.96 (95% Prediction Interval (PI): 246.77–249.15), $204.23 (95% PI: 202.70–205.75) and $195.01 (95% PI: 193.81–196.21) respectively. Comparatively, in the NPT arm, it costs $162.36 (95% PI: 161.43–163.28), $158.39 (95% PI: 157.62–159.15) and $149.17 (95% PI: 148.62–149.73), respectively. Using NPT resulted in cost savings of 34.52%, 22.45% and 23.51%, respectively. Among all the testing strategies, substantial difference in cost per client tested between the standard care arm and the NPT arm was observed for contacts of CT or NG, varying from 27.37% to 35.28%. Conclusion: We found that NPT is cost-saving compared with standard clinical care for individuals with STI symptoms and sexual contacts of CT, NG, and MG.

Published in Journal of Infection and Public Health

ISSN: 1876-0341 (Print); 1876-035X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Infectious and parasitic diseases; Medicine: Public aspects of medicine
Website: https://www.journals.elsevier.com/journal-of-infection-and-public-health

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