E-screening for sexually transmissible infections and blood-borne viruses in New South Wales, Australia: a cost analysis.

BACKGROUND

MyCheck is an e-testing pathway, first implemented at Sydney Sexual Health Centre, which enhances access to STI/HIV testing via telehealth and off-site sample collection; thus, reducing clinic visits. This study evaluates MyCheck's direct and indirect costs versus standard in-person screening (Xpress).

METHODS

A 12-month bottom-up cost analysis from a societal perspective compared MyCheck and Xpress. Direct medical (health system), direct non-medical (patient travel) and indirect non-medical (productivity) costs were calculated using retrospective Sydney Sexual Health Centre data. Costs included pathology, staff time, overheads, consumables, patient travel and forgone productivity. Statewide scale-up costs were estimated, with sensitivity analyses adjusting for inflation, minimum wage and an increase in the proportion of MyCheck users with productivity loss.

RESULTS

From January to July 2023, Sydney Sexual Health Centre conducted 2548 screening episodes (45% MyCheck, 55% Xpress), with MyCheck attracting more men who have sex with men/transgender and gender diverse patients. MyCheck's shorter appointments (median 5 min vs Xpress's 15 min) led to lower staff costs (A$5 vs A$16). MyCheck had higher overall health system cost (A$127/patient) compared with Xpress (A$91/patient), mostly due to pathology costs. However, considering patient travel cost and productivity loss for Xpress, MyCheck's societal cost (A$137) was lower than Xpress (A$146), yielding A$104,260 annual savings. Statewide scale-up provides significant societal savings (A$419,077/year).

CONCLUSION

This analysis of MyCheck's direct and indirect costs compared with traditional in-person screening demonstrates significant societal savings, despite higher direct pathology costs. It underscores the importance of a broader societal perspective in cost analyses. Lowering private pathology costs could further enhance MyCheck's cost-effectiveness. MyCheck, an innovative e-screening pathway, reduces barriers for STI/blood-borne virus screening by improving patient convenience and reduced opportunity costs. Despite higher direct pathology costs, its societal cost savings support statewide scale-up for improved screening accessibility.