Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK

Abstract

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.

Systematic reviews of point-of-care tests for the diagnosis of urogenitalChlamydia trachomatisinfections

“…Gift et al described the rapid test paradox in a model of chlamydial screening in which a rapid test of 65% sensitivity led to more infected patients being treated than using a NAAT with higher accuracy because of low patient return rates for results 9. Adams et al 14 examined the need to modify patient pathways to take full advantage of near-patient NAATs, which can reduce cost and clinician time and may lead to more efficient and appropriate care for patients compared with standard of care which is off-site laboratory testing and having to return for test results and treatment. In a simulation of 1.2 million patients seeking STI care across the UK, it was estimated that POC testing can be cost-saving and reduce overtreatment of patients who are diagnosed using a syndromic approach 15.…”

Impact of deploying multiple point-of-care tests with a ‘sample first’ approach on a sexual health clinical care pathway. A service evaluation

“…25 However, the adoption by SHCs of POCTs that enable test-and-treat strategies is also dependent on the cost of the tests, and the funding structures in place. Sexual health commissioning in England is complex, with regional, provider and reimbursement type (tariff vs block) differences.…”

Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the ‘Test n Treat’ feasibility trial

“…However, data on the costs of providing community-based services are limited. Previous cost analyses have primarily focused on using POC CT/NG tests in clinical settings and/or based on modelled data [9][10][11]. There is an urgent need for real life data to explore the economics and practicalities of screening and treatment of STIs in the community.…”