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Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia
  1. Jason J Ong1,2,3,
  2. Aaron Lim4,
  3. Catriona Bradshaw1,3,
  4. David Taylor-Robinson5,
  5. Magnus Unemo6,7,
  6. Paddy J Horner4,
  7. Peter Vickerman4,
  8. Lei Zhang1,3,8
  1. 1Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  4. 4Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  5. 5Faculty of Medicine, Imperial College London, London, UK
  6. 6WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Orebro, Sweden
  7. 7Institute for Global Health, University College London, London, UK
  8. 8China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
  1. Correspondence to Dr Jason J Ong, Monash University, 580 Swanston Street, Carlton, Victoria 3053, Australia;{at}


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

Data availability statement

Data are available upon reasonable request.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.