{
  "abstract": "Objectives 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.",
  "authors": [
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Caroline G Watts"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Louise M Causer"
    },
    {
      "affiliations": [
        "International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia"
      ],
      "name": "Susan J Matthews"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Kirsty Smith"
    },
    {
      "affiliations": [
        "International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia"
      ],
      "name": "Kelly Andrewartha"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Annie Tangey"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Ben B Hui"
    },
    {
      "affiliations": [
        "Nganampa Health Council, South Australia, New South Wales, Australia"
      ],
      "name": "Rae-Lin Huang"
    },
    {
      "affiliations": [
        "Infection and Global Health Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia",
        "Burnet Institute, Melbourne, Victoria, Australia"
      ],
      "name": "David Anderson"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia",
        "Cepheid, Sunnyvale, California, USA"
      ],
      "name": "Steven G Badman"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Basil Donovan"
    },
    {
      "affiliations": [
        "Central Clinical School, Monash University, Melbourne, Victoria, Australia",
        "Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia"
      ],
      "name": "Christopher K Fairley"
    },
    {
      "affiliations": [
        "Public Health Unit, Northern Territory Centre for Disease Control, Casuarina, Northern New South Wales, Australia"
      ],
      "name": "Manoji Gunathilake"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Belinda Hengel"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "John Kaldor"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia",
        "Burnet Institute, Melbourne, Victoria, Australia"
      ],
      "name": "Lisa Maher"
    },
    {
      "affiliations": [
        "The University of Notre Dame Australia, Perth, Western Australia, Australia",
        "Communicable Disease Control Directorate, Western Australia Department of Health, Perth, Western Australia, Australia"
      ],
      "name": "Donna B Mak"
    },
    {
      "affiliations": [
        "Cepheid, Sunnyvale, California, USA"
      ],
      "name": "David Persing"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "David G Regan"
    },
    {
      "affiliations": [
        "International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia"
      ],
      "name": "Mark D Shephard"
    },
    {
      "affiliations": [
        "Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia"
      ],
      "name": "David Speers"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Handan Wand"
    },
    {
      "affiliations": [
        "Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia"
      ],
      "name": "James Ward"
    },
    {
      "affiliations": [
        "UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia",
        "Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia"
      ],
      "name": "David Whiley"
    },
    {
      "affiliations": [
        "Aboriginal Health Council of Western Australia, Highgate, Western Australia, Australia"
      ],
      "name": "Caitlyn S White"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia",
        "Department of Global Health and Tropical Medicine, London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Virginia Wiseman"
    },
    {
      "affiliations": [
        "Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Rebecca J Guy"
    }
  ],
  "title": "Cost-effectiveness of a decentralised molecular point-of-care testing programme for sexually transmitted infections in remote primary care health services in Australia",
  "uid": "61379005-2b6e-5e02-a584-cc90058b6a31"
}