Abstract
The increasing prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae has required replacing inexpensive oral ciprofloxacin treatment with more expensive injectable ceftriaxone. Further, monitoring antimicrobial resistance requires culture testing, but nonculture gonorrhea tests are rapidly replacing culture. Since the strategies were similar in effectiveness (> 99%), we evaluated, from the healthcare system perspective, cost-minimizing strategies for both diagnosis (culture followed by antimicrobial susceptibility tests versus nonculture-based tests) and treatment (ciprofloxacin versus ceftriaxone) of gonorrhea in women. Our results indicate that switching from ciprofloxacin to ceftriaxone is cost-minimizing (i.e., optimal) when the prevalence of gonorrhea is > 3% and prevalence of ciprofloxacin resistance is > 5%. Similarly, culture-based testing and susceptibility surveillance are optimal when the prevalence of gonorrhea is < 13%; nonculture-based testing is optimal (cost-minimizing) when gonorrhea prevalence is > or = 13%.
Highlights
Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS Economic Evaluation Database (NHS EED)
The cost categories considered were non-culture test (CT), CT, antimicrobial susceptibility test, care associated with pelvic inflammatory disease (PID) and sequelae, outpatient treatment of epididymitis, clinician visits, CEF and CIP, and resources associated with the transmission of gonorrhoea and human immunodeficiency virus (HIV)
Authors' conclusions The choice of the optimal strategy for the diagnosis and treatment of gonorrhoea in US women depended on several factors, including the prevalence of gonorrhoea and the prevalence of ciprofloxacin (CIP)-resistant gonococcal strains
Summary
Modelling A decision tree was constructed to assess the cost-effectiveness of the four diagnosis and treatment strategies in a hypothetical cohort of one million women. Outcomes assessed in the review The outcomes assessed from the literature were: the prevalence of disease; the rates of treatment failure; the rates of infected and non-infected, and symptomatic and asymptomatic women; accuracy of the tests; the rates of concurrent transmission of the human immunodeficiency virus (HIV); the rates of PID and sequelae; the rates of urethritis and epididymitis; the rates of culture-positive samples; and the rates of gonorrhoea transmission. Estimates of effectiveness and key assumptions The prevalence of CEF-resistant Neisseria gonorrhoeae was 0%.
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