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. 2023 Apr 18;227(8):1007-1018.
doi: 10.1093/infdis/jiad047.

The Estimated Lifetime Quality-Adjusted Life-Years Lost Due to Chlamydia, Gonorrhea, and Trichomoniasis in the United States in 2018

Yunfei Li  1 , Shiying You  2 , Kyueun Lee  3 , Reza Yaesoubi  2 , Katherine Hsu  4 , Thomas L Gift  5 , Harrell W Chesson  5 , Andrés A Berruti  5 , Joshua A Salomon  6 , Minttu M Rönn  1
Affiliations

The Estimated Lifetime Quality-Adjusted Life-Years Lost Due to Chlamydia, Gonorrhea, and Trichomoniasis in the United States in 2018

Yunfei Li et al. J Infect Dis. .

Abstract

Background: Comprehensive evaluation of the quality-adjusted life-years (QALYs) lost attributable to chlamydia, gonorrhea, andtrichomoniasis in the United States is lacking.

Methods: We adapted a previous probability-tree model to estimate the average number of lifetime QALYs lost due to genital chlamydia, gonorrhea, and trichomoniasis, per incident infection and at the population level, by sex and age group. We conducted multivariate sensitivity analyses to address uncertainty around key parameter values.

Results: The estimated total discounted lifetime QALYs lost for men and women, respectively, due to infections acquired in 2018, were 1541 (95% uncertainty interval [UI], 186-6358) and 111 872 (95% UI, 29 777-267 404) for chlamydia, 989 (95% UI, 127-3720) and 12 112 (95% UI, 2 410-33 895) for gonorrhea, and 386 (95% UI, 30-1851) and 4576 (95% UI, 13-30 355) for trichomoniasis. Total QALYs lost were highest among women aged 15-24 years with chlamydia. QALYs lost estimates were highly sensitive to disutilities (health losses) of infections and sequelae, and to duration of infections and chronic sequelae for chlamydia and gonorrhea in women.

Conclusions: The 3 sexually transmitted infections cause substantial health losses in the United States, particularly gonorrhea and chlamydia among women. The estimates of lifetime QALYs lost per infection help to prioritize prevention policies and inform cost-effectiveness analyses of sexually transmitted infection interventions.

Keywords: burden of disease; chlamydia; gonorrhea; quality-adjusted life-years; sexually transmitted diseases; trichomoniasis‌.

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Conflict of interest statement

Potential conflicts of interest. M.M.R. reports contract from World Health Organization, not related to the manuscript, and grant from Harvard University Center for AIDS Research Developmental Grant, not related to the manuscript. S.Y. reports doctoral stipend from New York University Grossman School of Medicine, not related to the manuscript. All other authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Probability tree for sequelae of gonorrhea, chlamydia, or trichomoniasis among women (Panel A), with complications of PID shown in Panel B. Abbreviations: CPP, chronic pelvic pain; EP, ectopic pregnancy; PID, pelvic inflammatory disease; TFI, tubal factor infertility.
Figure 2.
Figure 2.
Probability tree for sequelae of gonorrhea, chlamydia, or trichomoniasis among men. Abbreviation: EDS, epididymitis.
Figure 3.
Figure 3.
Discounted lifetime QALYs lost per incident infection of chlamydia, gonorrhea, and trichomoniasis by sex and age group in the United States in 2018. Abbreviations: QALY, quality-adjusted life-year; UI, uncertainty interval.
Figure 4.
Figure 4.
Population-level number of discounted lifetime QALYs lost associated with infection of chlamydia, gonorrhea, and trichomoniasis by sex and age group in the United States in 2018. Abbreviations: QALY, quality-adjusted life-year; UI, uncertainty interval.
Figure 5.
Figure 5.
Population-level number of discounted lifetime QALYs lost per 1000 population associated with infection of chlamydia, gonorrhea, and trichomoniasis by sex and age group in the United States in 2018. Abbreviations: QALY, quality-adjusted life-year; UI, uncertainty interval.
Figure 6.
Figure 6.
Decomposition of total discounted lifetime QALYs lost by infections and sequelae of chlamydia, gonorrhea, and trichomoniasis by sex in the United States in 2018. The QALYs lost decomposed in this figure are the discounted lifetime QALYs lost per infection reported in Figure 3. The first bar for each of the 3 STIs for women represents the QALYs lost from the symptomatic infection itself. Bars 2 through 5 represent the QALYs lost due to each sequela (arising from both symptomatic and asymptomatic infection), and the sum of the proportions of QALYs lost from infection and sequelae for each infection is 100%. Means are indentified as historgrams and 95% UIs are indentified as error bars. Abbreviations: CPP, chronic pelvic pain; CT, chlamydia; EDS, epididymitis; EP, ectopic pregnancy; GC, gonorrhea; PID, pelvic inflammatory disease; TFI, tubal factor infertility; TV, trichomoniasis; UTS, urethritis.
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References

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