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Original research
Cost-effectiveness of two screening strategies for Chlamydia trachomatis and Neisseria gonorrhoeae as part of the PrEP programme in the Netherlands: a modelling study
  1. Francine van Wifferen1,2,
  2. Elske Hoornenborg1,
  3. Maarten F Schim van der Loeff1,
  4. Janneke Heijne2,
  5. Albert Jan van Hoek2
  1. 1Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  2. 2Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
  1. Correspondence to Dr Elske Hoornenborg, Department of Infectious Diseases, Public Health Service of Amsterdam, 1018 WT Amsterdam, Netherlands; ehoornenborg{at}


Objectives Pre-exposure prophylaxis (PrEP) users are routinely tested four times a year (3 monthly) for asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections on three anatomical locations. Given the high costs of this testing to the PrEP programme, we assessed the impact of 3 monthly screening(current practice), compared with 6 monthly on the disease burden. We quantified the difference in impact of these two testing frequencies on the prevalence of CT and NG among all men who have sex with men (MSM) who are at risk of an STI, and explored the cost-effectiveness of 3-monthly screening compared with a baseline scenario of 6-monthly screening.

Methods A dynamic infection model was developed to simulate the transmission of CT and NG among sexually active MSM (6500 MSM on PrEP and 29 531 MSM not on PrEP), and the impact of two different test frequencies over a 10-year period. The difference in number of averted infections was used to calculate incremental costs and quality-adjusted life-years (QALY) as well as an incremental cost-effectiveness ratio (ICER) from a societal perspective.

Results Compared with 6-monthly screening, 3-monthly screening of PrEP users for CT and NG cost an additional €46.8 million over a period of 10 years. Both screening frequencies would significantly reduce the prevalence of CT and NG, but 3-monthly screening would avert and extra ~18 250 CT and NG infections compared with 6-monthly screening, resulting in a gain of ~81 QALYs. The corresponding ICER was ~€430 000 per QALY gained, which exceeded the cost-effectiveness threshold of €20 000 per QALY.

Conclusions Three-monthly screening for CT and NG among MSM on PrEP is not cost-effective compared with 6-monthly screening. The ICER becomes more favourable when a smaller fraction of all MSM at risk for an STI are screened. Reducing the screening frequency could be considered when the PrEP programme is established and the prevalence of CT and NG decline.

  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • gay men
  • modelling
  • screening

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  • Handling editor Laith J Abu-Raddad

  • Contributors Study concept and design: AJvH, EH, MFSvdL, FvW. Model development: AJvH, FvW. Analysis and/or interpretation of the data: AJvH, EH, MFSvdL, FvW, JH. Drafting of the manuscript: FvW. Critical revision of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EH obtained advisory board fees and a research grant from Gilead Sciences; both of which were paid to her institute.

  • Patient consent for publication Not required.

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

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.