Online testing for sexually transmitted infections: A whole systems approach to predicting value.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
23
08
2017
accepted:
02
02
2019
entrez:
23
2
2019
pubmed:
23
2
2019
medline:
19
11
2019
Statut:
epublish
Résumé
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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 30794589
doi: 10.1371/journal.pone.0212420
pii: PONE-D-17-31063
pmc: PMC6386384
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0212420Déclaration de conflit d'intérêts
Paula Baraitser is a Director of the 'not-for-profit' company SH:24 that provided the online sexual health services in the areas studied. Authors confirm that this does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Infect Dis Obstet Gynecol. 2007;2007:62467
pubmed: 18273404
Fam Pract. 2004 Oct;21(5):528-36
pubmed: 15367475
Lancet Public Health. 2017 Apr;2(4):e182-e190
pubmed: 29253450
PLoS Med. 2017 Dec 27;14(12):e1002479
pubmed: 29281628
Sex Transm Dis. 2011 Sep;38(9):815-20
pubmed: 21844736
PLoS Med. 2013;10(4):e1001414
pubmed: 23565066
BMC Health Serv Res. 2015 Dec 05;15:540
pubmed: 26637295
Sex Transm Dis. 2015 Jan;42(1):13-9
pubmed: 25504295
Sex Transm Dis. 2006 Jul;33(7):451-7
pubmed: 16652069
Sex Transm Dis. 2005 Feb;32(2):139-41
pubmed: 15668622