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Abstract

Background

Widespread ceftriaxone antimicrobial resistance (AMR) threatens (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.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2020-10-29
2024-04-20
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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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Emma+M+Harding-Esch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harding-Esch Emma M</a>, <a href="/search?value1=Susie+E+Huntington&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Huntington Susie E</a>, <a href="/search?value1=Michael+J+Harvey&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harvey Michael J</a>, <a href="/search?value1=Georgie+Weston&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Weston Georgie</a>, <a href="/search?value1=Claire+E+Broad&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Broad Claire E</a>, <a href="/search?value1=Elisabeth+J+Adams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Adams Elisabeth J</a>, <a href="/search?value1=S+Tariq+Sadiq&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sadiq S Tariq</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2020;25(43):pii=1900402. <a href="https://doi.org/10.2807/1560-7917.ES.2020.25.43.1900402" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2020.25.43.1900402</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 21 Jun 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 22 Apr 2020 </span> </p>
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