Article Text

PDF
Original article
Impact of point-of-care management on the transmission of anogenital gonococcal infections among men who have sex with men in Amsterdam: a mathematical modelling and cost-effectiveness study
  1. Menne Bartelsman1,
  2. Kelsey Vaughan2,
  3. Martijn S van Rooijen1,3,4,
  4. Henry J C de Vries1,5,6,
  5. Maria Xiridou7
  1. 1STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  2. 2Bang for Buck Consulting, Amsterdam, The Netherlands
  3. 3Department of Research, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  4. 4Public Health Laboratory, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  5. 5Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
  6. 6Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
  7. 7Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  1. Correspondence to Menne Bartelsman, STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service of Amsterdam, Weesperplein 1, 1018 WZ Amsterdam, The Netherlands; menneb{at}hotmail.com

Abstract

Objective Point-of-care (POC) management may avert ongoing transmissions occurring between testing and treatment or due to loss to follow-up. We modelled the impact of POC management of anogenital gonorrhoea (with light microscopic evaluation of Gram stained smears) among men who have sex with men (MSM) on gonorrhoea prevalence and testing and treatment costs.

Methods Data concerning costs and sexual behaviour were collected from the STI clinic of Amsterdam. With a deterministic model for gonorrhoea transmission, we calculated the prevalence of gonorrhoea in MSM in Amsterdam and the numbers of consultations at our clinic over 5 years, in three testing scenarios: POC for symptomatic MSM only (currently routine), POC for all MSM and no POC for MSM.

Results Among MSM, 34.7% (109/314) had sexual contacts in the period between testing and treatment, of whom 22.9% (25/109) had unprotected anal intercourse. Expanding POC testing from symptomatic MSM to all MSM could result in an 11% decrease (IQR, 8%–15%) in gonorrhoea prevalence after 5 years and a cost increase of 8.6% (€2.40) per consultation and €86 118 overall (+8.3%). Switching from POC testing of symptomatic MSM to no POC testing could save €1.83 per consultation (6.5%) and €54 044 (−5.2%) after 5 years with a 60% (IQR, 26%–127%) gonorrhoea prevalence increase. Overtreatment was 2.1% (30/1411) with POC for symptomatic MSM only and 4.1% (68/1675) with POC for all MSM.

Conclusions In the Amsterdam setting, possible abandonment of POC testing of symptomatic MSM because of budget cuts could result in a considerable increase in gonorrhoea prevalence against a reduction in costs per consultation. Expanding POC testing to all MSM could result in a modest reduction in prevalence and a cost increase. While the costs and outcomes depend on specific local characteristics, the developed framework of this study is useful to evaluate POC management in other settings.

  • Neisseria Gonorrhoeae
  • cost-effectiveness analysis
  • point-of-care systems
  • mathematical model
  • infection transmission
  • overtreatment
  • lost to follow-up

Statistics from Altmetric.com

Footnotes

  • Handling editor Jackie A Cassell

  • Contributors MX, HJCdV and MB were the authors responsible for the design of the study. MX designed the mathematical model. MSvR and MB collected and interpreted the sexual behaviour data. KV collected and analysed the data of the costs. MB and MX drafted the paper. HJCdV and MX supervised the overall study. All authors reviewed and approved the final article.

  • Funding This study was financed by the Research and Development department of the Public Health Service of Amsterdam (No 2382).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.