Modelling cost-effectiveness of multipathogen POC tests for sexually transmitted infections

In this BMJ Open article, we report on health economic modelling results that compare three possible strategies for point-of-care (POC) sexually transmitted infection (STI) testing with the current practice of microscopy and lab-based testing.  Results showed that testing for STIs with either a dual, triple or quadruple POC test provided more patient benefit than current practice but may cost more. The quadruple POC test was the least expensive POC strategy relative to standard care – with an incremental cost-effectiveness ratio of £36,585 per quality adjusted life years gained, when taking the clinic’s perspective. When taking the commissioners’ perspective, who pay for the services delivered through tariffs, over £26 million in savings could be achieved using the 4-bug test, mainly because patients were treated appropriately on their first testing visit rather than having to re-attend.

 

PublicationHuntington SE, Burns RM, Harding-Esch E, et al.  ‘Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees.’ BMJ Open 2018;8:e020394. doi:10.1136/bmjopen-2017-020394

To request a copy of the published article, please email caroline.dombrowski@aquariusph.com.

Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections

Evaluating multi-bug point-of-care tests for sexually transmitted infections

We estimated costs, benefits and cost-effectiveness of three accurate 30-minute NAAT POCT strategies that detect different STI combinations, compared with standard care  (laboratory-based NAAT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)).  We found the CT-NG-MG-TV POCT strategy was the cheapest using tariff costing. It offered the most benefits, which in turn may have wider public health impacts through rapid and accurate STI diagnosis and management. Different testing strategies may be more cost-effective in different SHCs and patient groups. Further evidence is needed to capture the diversity of STI prevalence and management of patients across clinical services to better inform economic analyses.

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Harding-Esch EM, Huntington SE, Burns RM, et al. Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections STI & HIV World Congress. 9-12 July 2017. Rio de Janiero, Brazil.

 

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Modelling how point-of-care tests can enable personalised treatment for resistant gonorrhoea infections

We created a mathematical model to investigate the treatment impact and economic implications of introducing an antimicrobial resistance point-of-care test (AMR POCT) for gonorrhoea as a way of extending the life of current last-line treatments. The introduction of AMR POCT could allow clinicians to discern between the majority of gonorrhoea-positive patients with strains that could be treated with older, previously abandoned first-line treatments, and those requiring our current last-line dual therapy. Such tests could extend the useful life of dual ceftriaxone and azithromycin therapy, thus pushing back the time when gonorrhoea may become untreatable.

Publication

Turner KM, Christensen H, Adams EJ, et al Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study
BMJ Open 2017;7:e015447. doi: 10.1136/bmjopen-2016-015447

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Increased efficiency and improved treatment for stable HIV patients in England

Problem: There was no guidance in England on how frequently stable HIV patients should attend clinics for routine visits, how frequently they should receive their HIV drugs and whether or not it would be cost efficient for patients to collect their drugs from the hospital pharmacy (which incurs VAT) or receive them through a home delivery (with associated delivery cost).

Approach: We built a simple spreadsheet tool in Microsoft Excel to estimate which strategy was the most cost-efficient. Local data from St George’s hospital were obtained and analysed, and supplemented with nationally published data as inputs in the model. Results suggested that the most cost efficient way of delivering care was to see stable patients for routine visits every six months in clinic, and give them their drugs through home delivery every three months; this would also save the most drug wastage for example if patients needed to switch to a new drug regimen. Results suggested that this could save roughly £2000 per patient annually, and roughly £8 million if it were implemented across England to the 4000 HIV patients in 2012.

Impact: Results were given to the London HIV commissioners, published in a peer-reviewed journal, and the tool is available to healthcare professionals so that they can put in their local data to help them make better decisions about healthcare provision.

 

Testimonial

“It has been a pleasure to work with Dr Elisabeth Adams on our costing project for HIV home delivery of drugs. I have also worked with her on research related to the POPI study of chlamydia screening.

She has a very professional and thorough approach to her work, and is good at delivering to timelines. I can recommend her as a partner for future work.”

  • Dr Phillip Hay, Reader and Honorary Consultant, Sexual Health and HIV Medicine, St. George’s Hospital, London

 

Related publications

publication_iconAdams EJ, Ogden D, Ehrlich A, Hay P. Treatment for stable HIV patients in England: can we save costs and improve patient care? Journal of Health Services Research & Policy. Published online 29 Oct 2013, doi:10.1177/1355819613508176

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