Could home sexually transmitted infection specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care?
Could home sexually transmitted infection specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care?
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DOI：
10.1097/olq.0000000000000221
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发表时间：
2015-01
影响因子：
3.1
通讯作者：
Gaydos CA
中科院分区：
文献类型：
--
作者：
Blake DR;Spielberg F;Levy V;Lensing S;Wolff PA;Venkatasubramanian L;Acevedo N;Padian N;Chattopadhyay I;Gaydos CA
最近的一个示范项目评估的可行性，可接受性和成本的基于网络的性病检测和电子处方治疗计划（eSTI）的结果表明，这种方法可能是一个可行的替代诊所为基础的测试和治疗，但结果需要通过随机比较有效性试验证实。我们建立了一个决策树模型，比较：1）使用家庭收集试剂盒和电子处方进行简单治疗的eSTI筛查成本与2）从文献中推导出的转诊到标准诊所的STI筛查和治疗的假设成本。主要结果是检测到的性传播感染数量。从临床试验角度和医疗保健系统角度进行分析。eSTI战略检测到75例感染，诊所转诊战略检测到45例感染。从临床试验的角度来看，eSTI的总成本为94，938美元（检测到的STI为1，266美元），从医疗保健系统的角度来看，eSTI的总成本为96，088美元（检测到的STI为1，281美元）。从临床试验的角度来看，诊所转诊的总成本为87，367美元（1，941美元/检出性传播感染），从医疗保健系统的角度来看，为71，668美元（1，593美元/检出性传播感染）。结果表明，无论是在临床试验还是在常规临床护理中，eSTI都可能比基于诊所的STI筛查更具成本效益（检测到的成本/STI）。虽然我们的结果是有希望的，但它们是基于一个示范项目和其他小型研究的估计。需要进行比较有效性研究（CER）试验，以确定eSTI系统在识别和治疗新感染及其后遗症预防方面的实际成本和影响。
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. 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. 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. 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.