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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.
- Source :
-
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin [Euro Surveill] 2020 Oct; Vol. 25 (43). - Publication Year :
- 2020
-
Abstract
- BackgroundWidespread 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).AimAssess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use.MethodsThe 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).ResultsAll 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).ConclusionsAMR 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.
- Subjects :
- Ambulatory Care Facilities
Azithromycin economics
Azithromycin pharmacology
Azithromycin therapeutic use
Ceftriaxone economics
Ceftriaxone pharmacology
Ceftriaxone therapeutic use
Cost-Benefit Analysis
England
Humans
Neisseria gonorrhoeae drug effects
Sexual Health
Anti-Bacterial Agents economics
Anti-Bacterial Agents pharmacology
Anti-Bacterial Agents therapeutic use
Drug Resistance, Bacterial drug effects
Gonorrhea drug therapy
Gonorrhea microbiology
Point-of-Care Testing
Subjects
Details
- Language :
- English
- ISSN :
- 1560-7917
- Volume :
- 25
- Issue :
- 43
- Database :
- MEDLINE
- Journal :
- Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
- Publication Type :
- Academic Journal
- Accession number :
- 33124553
- Full Text :
- https://doi.org/10.2807/1560-7917.ES.2020.25.43.1900402