Faculty Opinions recommendation of Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis.

Abstract Background Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear. Methods Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay. Results In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9–8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1–2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000–22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%. Conclusions POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options.

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Milestone Approach to Designing a Point-of-Care Ultrasound Curriculum for Transition-to-Residency Programs in the United States

Teaching and Learning in Medicine ◽

10.1080/10401334.2020.1814296 ◽

2020 ◽

pp. 1-12

Author(s):

Ariel Sena ◽

Stephen Alerhand ◽

Sangeeta Lamba

Keyword(s):

United States ◽

Point Of Care ◽

The United States ◽

Point Of Care Ultrasound ◽

Residency Programs

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Regulatory Compliance for Point-of-Care Testing: A Perspective from the United States (Circa 2000)

Clinics in Laboratory Medicine ◽

10.1016/s0272-2712(18)30032-5 ◽

2001 ◽

Vol 21 (2) ◽

pp. 241-254 ◽

Cited By ~ 6

Author(s):

Elizabeth Lee-Lewandrowski ◽

Kent Lewandrowski

Keyword(s):

United States ◽

Point Of Care ◽

The United States ◽

Regulatory Compliance ◽

Point Of Care Testing

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2158. Cost-Effectiveness and Budget Impact of a Point-of-Care Nucleic Acid Amplification Test for Diagnosis of Group A Streptococcal Pharyngitis in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1838 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S732-S732

Author(s):

James Karichu ◽

Mindy Cheng ◽

Joanna Sickler ◽

Julie Munakata ◽

S Pinar Bilir ◽

...

Keyword(s):

United States ◽

Cost Effectiveness ◽

Nucleic Acid ◽

Budget Impact ◽

Point Of Care ◽

Cost Savings ◽

The United States ◽

Nucleic Acid Amplification ◽

Sensitivity Analyses ◽

Group A

Abstract Background Group A streptococcal (GAS) pharyngitis is common in the United States (US). Each year, approximately 12 million people seek medical care for pharyngitis, accounting for ~2% of ambulatory care visits. The gold standard method for diagnosing GAS is culture. However, because culture is time intensive, rapid antigen detection tests (RADTs), with or without culture confirmation, are commonly used. Although RADTs provide results quickly, test sensitivity has been shown to be sub-optimal, which can lead to inappropriate treatment decisions. Recently, highly sensitive point-of-care nucleic acid amplification tests (POC NAAT), such as the cobas® Liat® System, have emerged. The objective of this study was to evaluate the cost-effectiveness (CE) and budget impact (BI) of adopting POC NAAT compared with RADT+culture confirmation to diagnose GAS pharyngitis from the US third-party payer perspective. Methods A decision-tree economic model was developed in Microsoft Excel to quantify costs and clinical outcomes associated with POC NAAT and RADT+culture over a one-year period. All model inputs were derived from published literature and public databases. Model outputs included costs and clinical effects measured as quality-adjusted life days (QALDs) lost. One-way and probabilistic sensitivity analyses were performed to assess the impact of uncertainty on results. Results CE analysis showed that POC NAAT would cost $44 per patient compared with $78 with RADT+ culture. POC NAAT was associated with fewer QALDs lost relative to RADT+ culture. Therefore, POC NAAT may be considered the “dominant” strategy (i.e., lower costs and higher effectiveness). Findings were robust in sensitivity analyses. BI analysis showed that adopting POC NAAT for diagnosis of GAS could yield cost-savings of 0.3% vs. current budget over 3 years. This is due to savings associated with testing, GAS-related complications, antibiotic treatment and treatment-associated complication costs. Conclusion Results suggest that adopting POC NAAT to diagnose GAS would be considered cost-effective and yield cost-savings for US payers relative to RADT+culture. Access to POC NAAT would be important to optimize appropriate GAS diagnosis and treatment decisions. Disclosures All authors: No reported disclosures.

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Patient’s insurance status impact on biomarker testing in the United States market.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18114 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18114-e18114

Author(s):

Daniel F. Winkelman ◽

Amir Forouzan ◽

Mike Lavin ◽

Tanuja Tangudu ◽

Kristopher Custer ◽

...

Keyword(s):

United States ◽

Cancer Treatment ◽

Targeted Therapies ◽

Point Of Care ◽

Metastatic Cancer ◽

The United States ◽

Baseline Measure ◽

Data Set ◽

Insurance Type ◽

Biomarker Testing

e18114 Background: Precision medicine in cancer treatment is driven by biomarker testing. If a patient is not biomarker tested, he or she may not receive access to targeted therapies that often offer greater efficacy. The purpose of this research study is to examine the insurance type of patients that are untested for biomarkers in the United States. Methods: BrandImpact is a longitudinal panel of 450 Oncologists who continuously report cancer treatment decisions from the point-of-care. The BrandImpact data set includes 60,465 patient visits reported in 2018. This study followed market research best practices. This research included visits by patients diagnosed with metastatic: NSCLC, melanoma and ovarian cancer who were either tested or untested for the following biomarkers: EGFR, ALK, ROS1, PD-L1, BRAF and BRCA. Results: The baseline measure for this analysis is that 18% of the patient visits reported that were not biomarker tested. The table at the end of document outlines the untested patient visits by insurance type for comparison purposes. Conclusions: The rate of biomarker testing for metastatic cancer patients treated by Oncologists differs by insurance type. Patients with Medicare Only insurance (25%) are untested at a statistically significantly higher rate than the baseline All category. It should be noted that patients without insurance or who were cash-paying had the highest rates of being non-biomarker tested. It is recommended that further research be conducted into the reasons behind the significantly higher rate of non-testing for Medicare Only patients. It seems counter intuitive that this patient population is treated less than optimally due to limited access to targeted therapies. [Table: see text]

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