Cost-effectiveness Analysis of Chlamydia trachomatis Screening Via Internet-based Self-collected Swabs Compared With Clinic-based Sample Collection

Abstract

Background Although the Centers for Disease Control and Prevention have recommended population-wide Chlamydia trachomatis screening of sexually active women under 26 years of age, more than half of sexually active young women are not routinely screened. A Website, www.iwantthekit.org (IWTK), was developed in 2004 to promote home-based sample collection. Methods A decision tree was designed to model a hypothetical cohort of 10,000 women per year who order an internet-based Chlamydia trachomatis screening kit. We compared the incremental cost-effectiveness of two screening strategies, self-sampling via the IWTK Website; and traditional, clinic-based screening by the same cohort of women who used IWTK. Probabilities and costs were estimated for each node in the decision tree. Estimates were derived from primary data, published data, and unpublished health data. Results The internet-based screening strategy prevented 35.5 more cases of pelvic inflammatory disease and saved an additional $41,000 in direct medical costs as compared with the clinic-based screening strategy. Conclusion Our model estimates demonstrated that an internet-based, self- swab screening strategy was cost-effective compared with the traditional, clinic-based screening strategy. Assuming that the popularity of the use of the internet as a resource for information about healthcare and sexually transmitted infections leads to an increased use of IWTK, the public health benefit of this cost-effective strategy will be even greater.

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

“…10,20 In one, clinician time and STI test costs for clinic screening were compared with test kit, packaging, and postage costs for home screening. 20 Screening rates in the two strategies were assumed to be equal.…”

“…Another study included not only the costs of testing and treatment, but also the theoretical cost savings from prevention of PID. 10 Rates of screening in the internet sampling group were estimated to be higher than in the clinic group based on the authors’ primary data and the literature. The authors concluded that an internet-based self-swab screening strategy led to more PID prevented at a lower cost than clinic screening.…”

“…5,10,21 However, the availability of eRx in a web-based system has not been evaluated except in our demonstration study, 6 and requires validation in a larger comparative effectiveness trial. If the overall study prevalence of STIs (CT+GC+TV) is greater than our estimate of 8%, cost per STI detected in a future trial may be lower than results of this cost analysis suggest.…”

“…All eight of the infected women identified in the demonstration project were treated without DIS assistance. Given the small sample, estimates for the proportion of women who are successfully notified and treated were derived from the literature, 10 and we made the assumption that 10% would require DIS assistance.…”

Chlamyweb Study I: rationale, design and acceptability of an internet-based chlamydia testing intervention

“…The availability of nucleic acid amplification tests, since the late 1990s, and the ability to test urine and self-collected swabs have made this more feasible. Home-based self-sampling via the internet is acceptable and cost-effective if the return rate is as high as the clinic-based screening rate with 6% positivity 6. It is also convenient and easily accessible.…”