title: [More efficient testing policy at STI clinics].
abstract: OBJECTIVE
  To assess the efficiency of the testing policy change in 2012 in sexually transmitted infection (STI) outpatient clinics: persons who attend the clinic and are aged < 25 years without other risk factors are initially tested only for chlamydia, and only in the event of a positive test result will they be tested for other STIs. Other possible changes in the STI testing policy were explored.
  
  
  METHODS
  Explorative study.
  
  
  METHODS
  To test the new policy, data from STI outpatient clinics from 2011 were used for the risk group "young people under 25 years of age without other STI risks". Other groups who visited STI outpatient clinic were selected from the data from the STI outpatient clinics from 2012. Test cost savings and missed STIs were calculated if STI outpatient clinic attendees from these risk groups first received only a chlamydia or a combination test (chlamydia and gonorrhoea). Test cost savings were divided by the number of missed STIs as a measure of efficiency.
  
  
  RESULTS
  The policy change led to an annual test cost saving of € 1.1 million but missed 31 gonorrhoea infections (€ 36,200 at the cost of one missed gonorrhoea infection). Using a combination test for chlamydia and gonorrhoea in heterosexual individuals visiting the clinic aged < 25 years and not from a STI-endemic country could lead to test costs savings of € 3.8 million. Savings at the cost of one missed STI would be about € 350,000; 4 HIV and 7 syphilis infections would have been missed.
  
  
  CONCLUSIONS
  The national policy change has led to a substantial reduction in test costs. The policy measure would be even more efficient if a combination test for chlamydia and gonorrhoea were applied. Testing using a combination test in all heterosexual individuals who attend the clinic and are aged < 25 years and not from an STI-endemic country would lead to additional savings.
authors.affiliation: Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Bilthoven.
authors.forename: Anita W M
authors.initials: AW
authors.lastname: Suijkerbuijk
authors.forename: Eelco A B
authors.initials: EA
authors.lastname: Over
authors.forename: Femke D H
authors.initials: FD
authors.lastname: Koedijk
authors.forename: Birgit H B
authors.initials: BH
authors.lastname: van Benthem
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Anna K
authors.initials: AK
authors.lastname: Lugnér
mesh_terms: D000328:Adult; D000367:Age Factors; D002690:Chlamydia Infections / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis*; D015658:HIV Infections / Q000175:diagnosis; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D009426:Netherlands; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D055815:Young Adult