Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01605, USA.
Sex Transm Dis. 2011 Sep;38(9):815-20. doi: 10.1097/OLQ.0b013e31821b0f50.
Although the Centers for Disease Control and Prevention have recommended population-wide Chlamydia trachomatis screening of sexually active women less than 26 years of age, more than half of sexually active young women are not routinely screened. A Website (IWTK, www.iwantthekit.org), was developed in 2004 to promote home-based sample collection.
A decision tree was designed to model a hypothetical cohort of 10,000 women per year who order an internet-based C. trachomatis screening kit. We compared the incremental cost-effectiveness of 2 screening strategies: self-sampling via the IWTK website, and traditional, clinic-based screening by the same cohort of women who used IWTK. Probabilities and costs were estimated for each node in the decision tree. Estimates were derived from primary data, published data, and unpublished health data.
The internet-based screening strategy prevented 35.5 more cases of pelvic inflammatory disease and saved an additional $41,000 in direct medical costs as compared with the clinic-based screening strategy.
Our model estimates demonstrated that an internet-based, self-swab screening strategy was cost-effective compared with the traditional, clinic-based screening strategy. Assuming that the popularity of the use of the internet as a resource for information about healthcare and sexually transmitted infections leads to an increased use of IWTK, the public health benefit of this cost-effective strategy will be even greater.
尽管疾病控制与预防中心建议对所有年龄在 26 岁以下的有性生活的女性进行沙眼衣原体普查，但仍有一半以上有性生活的年轻女性未进行常规筛查。2004 年开发了一个网站（IWTK，www.iwantthekit.org），以促进家庭样本采集。
设计了一个决策树来模拟每年有 10000 名女性订购互联网沙眼衣原体筛查试剂盒的假设队列。我们比较了两种筛查策略的增量成本效益：通过 IWTK 网站进行自我采样，以及同一队列的女性通过传统的基于诊所的筛查。决策树中每个节点的概率和成本都是估算的。估计值来自于原始数据、已发表的数据和未发表的健康数据。
与基于诊所的筛查策略相比，基于互联网的筛查策略可预防 35.5 例盆腔炎，节省了 41000 美元的直接医疗费用。
我们的模型估计表明，与传统的基于诊所的筛查策略相比，基于互联网的自我采样筛查策略具有成本效益。假设互联网作为医疗保健和性传播感染信息资源的使用普及会导致 IWTK 的使用增加，那么这种具有成本效益的策略将带来更大的公共卫生效益。
