Objectives Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective.
Methods We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective.
Results Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective.
Conclusion Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
- Mycoplasma genitalium
- ANTIMICROBIAL RESISTANCE
Data availability statement
Data are available upon reasonable request.
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Handling editor Nicola Low
Contributors JJO and LZ conceived the research idea. JJO, AL, PV and LZ constructed the dynamic transmission model and conducted the economic evaluation. JJO drafted the first manuscript. All authors contributed to the writing of the paper and approved the final version. JO accepts full responsibility for the work, had access to the data, and controlled the decision to publish.
Funding This work was supported by the Australian National Health and Medical Research Council Emerging Leader Fellowship (GNT1193955).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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