PIN94 Beyond Acute Neisseria gonorrhoea Infection: A Model-Based Analysis Estimating the Holistic Humanistic Burden in England and the USA

Abstract

An increase in Neisseria gonorrhoeae (Ng) incidence and antimicrobial resistance (AMR) is currently observed in England and the USA. Understanding the full humanistic burden of Ng infection, defined as the comprehensive impact on a patient's health-related quality of life (HRQoL), is important to inform prevention interventions. We assessed the humanistic burden of Ng infections in England and the USA, including long-term health problems and AMR impact, which previous studies have not fully addressed. Using incidence data and a lifetime horizon Markov model, Ng infections were simulated in three sexually-active cohorts (aged 13–75 years): women, men-having-sex-with-men (MSM) and men-having-sex-with-women (MSW). A decision tree assigned probabilities and quality-adjusted-life-years (QALY) losses due to acute Ng infection and long-term health problems e.g., pelvic inflammatory disease (PID) or chronic pelvic pain (CPP). The impact of AMR on HRQoL was modelled by varying AMR prevalence and its impact on long-term health-problems. All inputs were from the literature. Discount rates of 3.5% (England) / 3% (USA) were applied. Over lifetime, a total of 72,647 (England)/988,396 (USA) Ng infections were projected to occur, resulting in 4,680/73,209 discounted QALYs lost. Of the total QALYs lost, 95%/96% occurred in women, who had a higher average discounted QALY loss of 0.1678/0.1870 per Ng infection, versus 0.0063/0.0060 for MSM and 0.0030/0.0034 for MSW. The majority of QALYs lost (67%/67%) were attributable to the long-term health problem CPP. Higher QALY losses were observed for resistant and untreated Ng infections, with up to 5,182/81,589 total QALYs lost in AMR scenarios. Ng infections cause a significant humanistic burden, especially in women. Highest QALY loss occurs in resistant and untreated infections, and since Ng incidence rates and AMR are expected to increase in the future, the humanistic burden due to Ng is likely to surge substantially.