Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics

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dc.contributor.authorHarding-Esch, Emma M.
dc.contributor.authorHuntington, Susie E.
dc.contributor.authorHarvey, Michael J.
dc.contributor.authorWeston, Georgie
dc.contributor.authorBroad, Claire E.
dc.contributor.authorAdams, Elisabeth J.
dc.contributor.authorSadiq, S. Tariq
dc.date.accessioned2022-12-14T02:34:13Z
dc.date.available2022-12-14T02:34:13Z
dc.date.issued2020-10-29
dc.description.abstractBackground: Widespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin). Aim: Assess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use. Methods: The five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained). Results: All strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706). Conclusions: AMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.en_US
dc.identifier.citationHarding-Esch, E. M., Huntington, S. E., Harvey, M. J., Weston, G., Broad, C. E., Adams, E. J., & Sadiq, S. T. (2020). Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 25(43), 1900402. https://doi.org/10.2807/1560-7917.ES.2020.25.43.1900402en_US
dc.identifier.otherDOI: 10.2807/1560-7917.ES.2020.25.43.1900402
dc.identifier.urihttps://hdl.handle.net/20.500.14041/4649
dc.language.isoen_USen_US
dc.publisherEuro Surveillance : European Communicable Disease Bulletinen_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subjectNeisseria Gonorrhoeaeen_US
dc.subjectSexually Transmitted Infectionen_US
dc.subjectAntimicrobial Resistanceen_US
dc.subjectPoint-of-Care Testingen_US
dc.subjectCost-Effectivenessen_US
dc.subjectCeftriaxoneen_US
dc.subjectCiprofloxacinen_US
dc.subjectAzithromycinen_US
dc.titleAntimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinicsen_US
dc.typeArticleen_US
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