Cost-effectiveness of a decentralised molecular point-of-care testing programme for sexually transmitted infections in remote primary care health services in Australia

Caroline G Watts; Louise M Causer; Susan J Matthews; Kirsty Smith; Kelly Andrewartha; Annie Tangey; Ben B Hui; Rae-Lin Huang; David Anderson; Steven G Badman; Basil Donovan; Christopher K Fairley; Manoji Gunathilake; Belinda Hengel; John Kaldor; Lisa Maher; Donna B Mak; David Persing; David G Regan; Mark D Shephard; David Speers; Handan Wand; James Ward; David Whiley; Caitlyn S White; Virginia Wiseman; Rebecca J Guy

doi:10.1136/sextrans-2025-056863

Cost-effectiveness of a decentralised molecular point-of-care testing programme for sexually transmitted infections in remote primary care health services in Australia

Sex Transm Infect. 2026 Jun 29:sextrans-2025-056863. doi: 10.1136/sextrans-2025-056863. Online ahead of print.

Authors

Caroline G Watts¹, Louise M Causer², Susan J Matthews³, Kirsty Smith², Kelly Andrewartha³, Annie Tangey², Ben B Hui², Rae-Lin Huang⁴, David Anderson^{5

6}, Steven G Badman^{2

7}, Basil Donovan², Christopher K Fairley^{8

9}, Manoji Gunathilake¹⁰, Belinda Hengel², John Kaldor², Lisa Maher^{2

6}, Donna B Mak^{11

12}, David Persing⁷, David G Regan², Mark D Shephard³, David Speers¹³, Handan Wand², James Ward¹⁴, David Whiley^{15

16}, Caitlyn S White¹⁷, Virginia Wiseman^{2

18}, Rebecca J Guy²

Affiliations

¹ Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia cwatts@kirby.unsw.edu.au.
² Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
³ International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia.
⁴ Nganampa Health Council, South Australia, New South Wales, Australia.
⁵ Infection and Global Health Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
⁶ Burnet Institute, Melbourne, Victoria, Australia.
⁷ Cepheid, Sunnyvale, California, USA.
⁸ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁹ Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
¹⁰ Public Health Unit, Northern Territory Centre for Disease Control, Casuarina, Northern New South Wales, Australia.
¹¹ The University of Notre Dame Australia, Perth, Western Australia, Australia.
¹² Communicable Disease Control Directorate, Western Australia Department of Health, Perth, Western Australia, Australia.
¹³ Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia.
¹⁴ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia.
¹⁵ UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
¹⁶ Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia.
¹⁷ Aboriginal Health Council of Western Australia, Highgate, Western Australia, Australia.
¹⁸ Department of Global Health and Tropical Medicine, London School of Hygiene & Tropical Medicine, London, UK.

PMID: 42373317
DOI: 10.1136/sextrans-2025-056863

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.

Keywords: Chlamydia trachomatis; Gonorrhea; Point-of-Care Testing; SEXUAL HEALTH; TRICHOMONAS.