Online testing for sexually transmitted infections: A whole systems approach to predicting value

Autor: Katy Turner, Jonathan Syred, Adam K. Zienkiewicz, Katharine J Looker, Paula Baraitser
Rok vydání: 2017
Předmět:
Male
Bacterial Diseases
Systems Analysis
Cost effectiveness
Total cost
Economics
Cost-Benefit Analysis
Social Sciences
Treponematoses
Chlamydia Infection
0302 clinical medicine
London
Medicine and Health Sciences
Medicine
030212 general & internal medicine
Medical diagnosis
Chlamydia
Average cost
Geographic Areas
Reproductive health
Multidisciplinary
Geography
HIV diagnosis and management
Test (assessment)
Infectious Diseases
Female
Anatomy
0305 other medical science
Research Article
Neglected Tropical Diseases
Urban Areas
medicine.medical_specialty
Science
Urology
Cost-Effectiveness Analysis
Sexually Transmitted Diseases
Online Systems
03 medical and health sciences
Predictive Value of Tests
Humans
Syphilis
Unit cost
Service (business)
030505 public health
Bacteria
business.industry
Diagnostic Tests
Routine
Genitourinary Infections
Organisms
Rectum
Biology and Life Sciences
Tropical Diseases
Economic Analysis
Diagnostic medicine
Gastrointestinal Tract
Family medicine
Earth Sciences
business
Digestive System
Zdroj: PLoS ONE
PLoS ONE, Vol 14, Iss 2, p e0212420 (2019)
Turner, K M E, Looker, K J, Syred, J, Zienkiewicz, A & Baraitser, P 2019, ' Online testing for sexually transmitted infections : A whole systems approach to predicting value ', PLoS ONE, vol. 14, no. 2, e0212420, pp. e0212420 . https://doi.org/10.1371/journal.pone.0212420
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0212420
Popis: BACKGROUND: Online testing for sexually transmitted infections has a lower unit cost than testing in clinical services and economic analysis has focused on the cost per test and cost per diagnosis in clinics and online. However, online services generate new demand for testing and shift activity between services, requiring system-level analysis to effectively predict cost-effectiveness.METHODS AND FINDINGS: Routinely collected, anonymised, retrospective data on sexual health service activity from all specialist services (clinic and online) within an inner London sexual health economy were collated and harmonised to generate a complete dataset of individual level clinic attendances. Clinic activity and diagnoses were coded using nationally standardised codes assigned by clinicians. Costs were taken from locally or regionally agreed sexual health tariffs. The introduction of online services changed patterns of testing. In an inner London sexual health economy, online STI testing increased total number of tests, the total cost of testing and total diagnoses while slightly reducing the average cost per diagnosis. Two years after the introduction of online services 37% of tests in the were provided online and total diagnoses increased. The positivity of online services is generally lower than that in clinics but varies between contexts. Where the positivity ratio between clinic and online is less than the cost ratio, online services will reduce cost per diagnosis. In this analysis, areas with different classifications as urban and rural had different clinic/online positivity ratios changing the cost effectiveness between areas. Even after the introduction of online services, simple STI testing activity continues in clinics and providers should consider online-first options where clinically appropriate.CONCLUSIONS: Online services for STI testing are not 'stand alone'. They change STI testing behaviour with impacts on all elements of the sexual health economy. Planning, development and monitoring of such services should reference the dynamic nature of these systems and the role of online services within them.
Databáze: OpenAIRE
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