Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2007, Article ID 62467, 5 pages doi:10.1155/2007/62467 Research Article Cost Comparisons between Home- and Clinic-Based Testing for Sexually Transmitted Diseases in High-Risk Young Women Kenneth J. Smith,1 Robert L. Cook,2 and Roberta B. Ness3 1 Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA 2 Departments of Epidemiology & Biostatistics and Medicine, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA 3 Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA Correspondence should be addressed to Kenneth J. Smith, smithkj2@upmc.edu Received 8 August 2007; Accepted 15 October 2007 Home testing for chlamydia and gonorrhea increases screening rates, but the cost consequences of this intervention are unclear. We examined the cost diﬀerences between home-based and clinic-based testing and the cost-eﬀectiveness of home testing based on the DAISY study, a randomized controlled trial. Direct and indirect costs were estimated for home and clinic testing, and cost- eﬀectiveness was calculated as cost per additional test performed. In the clinic testing group, direct costs were $49/test and indirect costs (the costs of seeking or receiving care) were $62/test. Home testing cost was $25/test. We found that home testing was cost saving when all testing for all patients was considered. However cost savings were not seen when only asymptomatic tests or when patient subgroups were considered. A home testing program could be cost saving, depending on whether changes in clinic testing frequency occur when home testing is available. Copyright © 2007 Kenneth J. Smith et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. INTRODUCTION Home testing for chlamydia and gonorrhea has high sensitiv- ity (about 90%) andspeciﬁcity (>99%), and is well accepted in adolescent and young adult populations [1–3]. Studies in the US and in Denmark demonstrate that home testing sig- niﬁcantly increases the likelihood that tests will occur [1, 2]. It is well established that oﬃce-based screening for chlamy- dia is a cost-eﬀective intervention for sexually active young women [3–5], as is screening for gonorrhea in women with individual or population risk factors [6, 7], however screen- ing in clinical settings is not performed as often as is recom- mended [8, 9]. Home screening, while increasing test frequency, might decrease screening costs, by avoiding clinical facility and clin- ician fees [1]. The indirect costs of clinic-based screening, such as time oﬀ work or school, childcare, transportation, and other costs resulting from a clinic visit, could also be averted. In this analysis, we use test frequency and cost data from a randomized trial of home testing for chlamydia and gonorrhea in high-risk young women to examine cost diﬀer- ences between home-based and clinic-based testing and the cost-eﬀectiveness of a home testing intervention. 2. MATERIALS AND METHODS The data source for this analysis was the Detection Accept- ability Intervention for STD’s in Young women (DAISY) study, a randomized controlled trial. Trial recruitment and results are detailed elsewhere [1]. Brieﬂy, 398 young women aged 15–24 at high risk for STD were recruited from clin- ics and surrounding communities, representing a group where frequent testing is recommended. Recruitment oc- curred between November 2000-April 2003. Women were randomized to an intervention group, who received home testing kits for chlamydia and gonorrhea by mail at 6, 12, and 18 months, or a control group, who received a postcard at 6, 12, and 18 months inviting them to at- tend one of the participating study clinics for a rou- tine test for women’s health infections at no cost. Par- ticipants were urged to maintain their usual health pat- terns, including evaluation for genital symptoms or STD’s. Women with positive home tests were notiﬁed, counseled about partner notiﬁcation, and referred to a participating clinic for treatment at no cost. Signiﬁcantly more screen- ing tests were performed in the home screening interven- tion group, and no diﬀerences in STD incidence rates were