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. 2020 Oct;25(43):1900402.
doi: 10.2807/1560-7917.ES.2020.25.43.1900402.

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

Emma M Harding-Esch  1   2 , Susie E Huntington  3 , Michael J Harvey  3 , Georgie Weston  3 , Claire E Broad  1 , Elisabeth J Adams  3 , S Tariq Sadiq  1   2   4
Affiliations

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

Emma M Harding-Esch et al. Euro Surveill. 2020 Oct.

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.

Keywords: Neisseria gonorrhoeae; Sexually transmitted infection; antimicrobial resistance; azithromycin; ceftriaxone; ciprofloxacin; cost-effectiveness; point-of-care test.

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Conflict of interest statement

Conflict of interest: SEH, MJH, GW and EJA are employees of Aquarius Population Health (APH) which reports grants on STI and POC research outside the submitted work from Innovate UK, Cepheid, St Georges University of London, Enigma Diagnostics, and AstraZeneca. EHE, CEB and STS are members of the Applied Diagnostic Research and Evaluation Unit at St George’s, University of London, which has received funding from Binx Health, Alere, Cepheid, SpeeDx and Sekisui.

References

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