OBJECTIVES: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) are sexually transmitted pathogens that often present as infections with similar symptoms, posing diagnostic challenges for clinicians. Inappropriately treated or untreated sexually transmitted infections (STIs) can lead to substantial costs in terms of unnecessary antibiotic use, additional physician visits, and even downstream complications such as pelvic inflammatory disease and infertility. Innovative, multiplex point-of-care testing may improve care thereby reducing costs and improving outcomes particularly associated with antibiotic stewardship. We set out to develop a decision modeling framework that assesses the economic impact of multiplex point-of-care testing for CT, NG, and MG compared to current standard care practice (laboratory-based testing and/or treatment without testing).
METHODS: We reviewed the literature to characterize the unmet needs, disease prevalence, burden, and existing clinical and economic data. The influence of diagnostics at different points in the treatment pathway was considered. This was used to create a patient pathway and unmet needs conceptual framework, which was validated with experts and advisors.
RESULTS: A decision-tree modeling framework was developed to assess the economic impact of multiplex point-of-care testing for CT, NG, and MG compared with current standard practice. Data inputs incorporated into the model included pathogen epidemiology (reported cases), percentage of infections with inappropriate treatment, antibiotic use, sequelae rates, costs, and quality-of-life. This framework was able to capture improvement of antibiotic stewardship and associated costs while measuring the impact on disease sequelae and the need for physician visits associated with subsequent care.
CONCLUSIONS: Innovative diagnostic solutions are urgently needed to address sexually transmitted infections. Having the proper decision modeling framework to assess the impact of being able to provide rapid results of multiplex testing to guide clinical decision-making and appropriate treatment at the place of care is important for understanding antibiotic stewardship and overall disease burden.
