Cost-effectiveness of a decentralised molecular point-of-care testing programme for sexually transmitted infections in remote primary care health services in Australia
Caroline G Watts, Louise M Causer, Susan J Matthews, Kirsty Smith, Kelly Andrewartha, Annie Tangey, Ben B Hui, Rae-Lin Huang, David Anderson, Steven G Badman, Basil Donovan, Christopher K Fairley, Manoji Gunathilake, Belinda Hengel, John Kaldor, Lisa Maher, Donna B Mak, David Persing, David G Regan, Mark D Shephard, David Speers, Handan Wand, James Ward, David Whiley, Caitlyn S White, Virginia Wiseman, Rebecca J GuyObjectives
In remote Australian First Nations communities, the burden of curable sexually transmitted infections (STIs) is highest for young women and men aged 16–29 years and for women is associated with two-fold higher rates of hospitalisations for pelvic inflammatory disease (PID) than for non-First Nations women. Following a randomised trial, decentralised community-led molecular point-of-care (POC) testing for STIs has operated in remote primary care across Australia for more than 7 years, improving uptake and timeliness of treatment for chlamydia, gonorrhoea and trichomonas infections. However, cost-effectiveness remains unknown.
Methods
A decision analytic model was devised to compare costs and outcomes associated with a POC testing programme for chlamydia, gonorrhoea and trichomonas infections in women and men aged 16–29 years seeking care, compared with standard care (laboratory-based testing). The analysis used a government payer perspective and 10-year time horizon. The primary outcome was the cost ($A) per quality-adjusted life year (QALY) gained. Sensitivity analyses examined uncertainty around the results.
Results
Based on a combined testing positivity rate of 36% and 29% for chlamydia, gonorrhoea and trichomonas for women and men, respectively, the POC testing programme, compared with laboratory testing, produced an estimated incremental cost per QALY ratio (ICER) of $A19 714 (95% CIs $A19 608 to $A19 821) over 10 years. Among those with an STI, the POC testing programme was predicted to reduce diagnosed PID by 30% and preterm/low birth weight babies by 17%. Sensitivity analyses indicated that the ICER was most sensitive to the probability of infection and receiving treatment within 2 days, based on a willingness-to-pay threshold of $A50 000.
Conclusion
This health economic evaluation indicates that a scaled molecular POC testing programme for the management of STIs in remote primary care settings is cost-effective compared with standard care. Sustained POC testing in this setting is likely to improve reproductive health outcomes.