Cost of the GetCheckedOnline program: Micro-costing analysis

Purpose

GetCheckedOnline (GCO) is a virtual testing platform that allows users to test for sexually transmitted infections (STIs, including Chlamydia, Gonorrhea, HIV, Syphilis and HCV) by creating their own lab requisition online, delivering specimens directly to a lab and retrieving results online. GCO’s implementation has progressed in four phases: 1) planning and consultation (01/2010-12/2011); 2) development (01/2012-08/2014); 3) pilot implementation (09/2014-12/2014); and 4) expansion (01/2015-03/2020) to selected British Columbia (BC) communities and regional health authorities. The objective of this study was to estimate the costs of GCO implementation and the cost per STI test executed via GCO.

Methods

Micro-costing analysis was conducted from a health care system perspective. We estimated resource use in four categories: labour inputs (salaries plus benefits for medical and non-medical personnel), web services (software development, business analysis/user experience design, security and privacy assessments, hardware, laboratory costs), training and capacity building, and promotion for each fiscal year (FY). Costs were annualized for equipment, services or other investments with a useful life longer than one year. All costs were presented in 2022 Canadian dollars. We calculated cost per STI test by: 1) dividing Phases 3 and 4 costs by total number of STI tests; 2) dividing the costs from the last two FYs (and each FY separately) by their corresponding number of tests because of increasing GCO testing capacity; 3) dividing costs in the four phases by total number of tests.

Results

The total cost of implementing GCO across four phases was $5.4M. Web services and labour inputs accounted for the majority the costs, with 53% vs. 47%, 57% vs. 42%, 60% vs. 34%, and 47% vs. 46% in Phases 1-4, respectively. A total of 86,012 STI tests (61,214 in the last two FYs) were completed during Phases 3 and 4. The cost per test was 1) $37.91; 2) $18.93 ($23.85 in FY2019 and $16.00 in FY2020); 3) $62.44, respectively.

Conclusions

These findings demonstrate the feasibility in financing and implementing a web-based STI testing program. Aside from providing individuals with a convenient and discrete option to access STI testing, substantial economies of scope and scale can be realized using this program. These findings can inform further studies in the incremental value and sustainability of the GCO program and its implementation in other settings.