ObjectivesWe aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current pathways using standard laboratory-based NAAT testing.Design/participantsWorkshops were conducted with healthcare professionals at four sexual health clinics representing diverse models of care in the UK. They mapped out current pathways that used chlamydia/gonorrhoea tests, and constructed new pathways using a POC NAAT. Healthcare professionals' time was assessed in each pathway.Outcome measureThe proposed POC pathways were then priced using a model built in Microsoft Excel, and compared to previously published costs for pathways using standard NAAT-based testing in an off-site laboratory.ResultsPathways using a POC NAAT for asymptomatic and symptomatic patients and chlamydia/gonorrhoea-only tests were shorter and less expensive than most of the current pathways. Notably, we estimate that POC testing as part of a sexual health screen for symptomatic patients, or as stand-alone chlamydia/gonorrhoea testing, could reduce costs per patient by as much as £16 or £6, respectively. In both cases, healthcare professionals' time would be reduced by approximately 10 min per patient.ConclusionsPOC testing for chlamydia/gonorrhoea in a clinical setting may reduce costs and clinician time, and may lead to more appropriate and quicker care for patients. Further study is warranted on how to best implement POC testing in clinics, and on the broader clinical and cost implications of this technology.

IFD was associated with longer length of stay and higher total overall cost of care, with attributable costs greater than £50 000 per case of IFD. Costs for inpatient stay far outstrip the cost of antifungal agents.

Objectives Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are sexually transmitted infections (STIs). Most infections are asymptomatic, representing an important reservoir for transmission. Without treatment, complications such as infertility may occur. Moreover, 33% of CT/NG co-infection rate has been reported. Since 2010, combined screening of CT and NG by PCR in asymptomatic population has been recommended by the French Health Authority. Thus, the aim of this study was to assess the interest of the new Cepheid Xpert ® CT/NG Assay, a real-time PCR test for the automated and rapid detection and differentiation of CT and NG genomic DNA, in population with systematically screening such as induced abortion. Methods Between July and November 2012, 634 urogenital samples were received in our laboratory to detect CT and/or NG infections with the Xpert CT/NG assay. Results Of the 634 samples included in this study, 61 (9.6%) were CT positive, 19 (2.9%) were NG positive. Among the 61 CT positives, 10 (1.6%) were positive for both CT and NG. Concerning the 177 samples performed in case of induced abortion, 27 (15.3%) were CT positive, 9 (5.1%) were NG positive and 5 (2.8%) were positive for both pathogens. Conclusion The results revealed a global prevalence (9.6%) of CT infections, this percentage being higher in women screened for induced abortion. Although, many clinicians tend to only request testing for CT, our results demonstrate the value of the detection of both CT and NG by Xpert CT/NG. This new test allows a more rapid, accurate detection and optimises the management of STIs by clinicians. Finally, the screening of asymptomatic population helps also to reduce the transmission and is a more cost effectiveness alternative in screening settings. Background We aimed to explore new patient pathways using a chlamydia/gonorrhoea (CT/NG) point of care nucleic acid amplification tests (POC NAAT), and estimate and compare the costs of the new pathways to the current pathways using standard laboratory-based NAAT testing. Methods A qualitative and quantitative approach was used. Focus groups were conducted with four sexual health clinics in the UK. They mapped out current pathways in which a CT/NG test was used, and then constructed new pathways using a POC NAAT. These pathways were then costed using a model built in Excel, and the cost of the current and POC NAAT pathways compared. Results Pathways using a POC NAAT for asymptomatic and symptomatic patients and CT/NG only tests were shorter and less expensive than most of the current pathways (average savings of £6-8 per pathway if the POCT costs £18 per test). Clinicians identified several potential benefits to introducing the test including faster time to treatment, more accurate diagnosis of symptomatic patients, and therefore less syndromic management, which is likely to result in better care for patients. Several theoretical risks and limitations were identified in the workshops although these were not assessed in the study. Conclusion A point of care test ...

Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support.

for both groups. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period between the HCV and comparison groups, adjusting for baseline demographic and clinical characteristics. Results: Eligible patients (N= 270,752) were identified for the HCV and comparison cohorts. After applying 1:1 PSM matching, a total of 107,953 patients were matched from each group and baseline characteristics were well-balanced. HCV patients were more likely to be hospitalized (15.90% vs. 3.19%, p< 0.01) and report more emergency room (20.36% vs. 8.17%, p< 0.01), physician office (99.18% vs. 61.06%, p< 0.01), outpatient (99.25% vs. 61.84%, p< 0.01) and pharmacy visits (91.11% vs. 63.13%, p< 0.01) which resulted in higher health care costs for inpatient