Volume 11, Number 8—August 2005
Research
Optimizing Treatment of Antimicrobial-resistant Neisseria gonorrhoeae
, Susan A. Wang*, and Martin I. Meltzer*
Table 3
Cost estimates
| Items | Costs (2001 US$) |
|||
|---|---|---|---|---|
| Base | Range | Distribution* | Sources | |
| Nonculture test for Neisseria gonorrhoeae | 7 | 5–20 | Triangular | Pers. comm.† |
| Culture test for N. gonorrhoeae | 5 | Pers. comm.† | ||
| Antimicrobial susceptibility tests | 20 | 5–60 | Uniform | Pers. comm.† |
| Weighted cost of symptomatic pelvic inflammatory disease (PID) and sequelae for untreated gonorrhea‡ | 3,250 | 3,000–3,500 | Uniform | 13,15,21,23 |
| Weighted cost of asymptomatic PID and sequelae for untreated gonorrhea‡ | 2,250 | 2,000–2,500 | Uniform | 13,15,21,23 |
| Outpatient case of epididymitis | 229 | 152–277 | Uniform | 13,15,21,23 |
| Inpatient case of epididymitis | 3,604 | 2,997–4,802 | Uniform | 13,15,21,23 |
| Clinic time: 5 min (routine checkup) | 15 | 40–70 | Uniform | 17,24 |
| Clinic time: 30 min (pelvic examination) | 60 | 5–20 | Uniform | 17,24 |
| Ciprofloxacin, 500 mg, oral | 2 | 1–6 | Uniform | 25,26 |
| Ceftriaxone, 125 mg, IM§ | 10 | 10–15 | Uniform | 25,26 |
| Onward transmission of gonorrhea to female, per case of gonorrhea¶ | 60 | 0–300 | Triangular | 14,21,22,23 |
| Onward transmission of HIV to male, per case of gonorrhea# | 130 | 0–1,000 | Triangular | 20,27,28 |
*The probability distributions used in the Monte Carlo sensitivity analysis. Uniform distributions were constructed with the minimum and maximum of the given ranges. Triangular distributions were constructed with the minimum and maximum of the given ranges, and the base case as the "most likely" value.
†Costs of culture and nonculture diagnostic tests were obtained from Dean Willis and Karla Schmitt, Florida State Department of Health. Costs of susceptibility testing were provided by Norman O'Connor, State of Hawaii Department of Health Laboratories Division, Roman Golash, Illinois Department of Public Health, and Paul Hannah, Orange County Public Health Laboratory, California.
‡Weighted using the probabilities (Table 2) of occurrence of PID (only), infertility, ectopic pregnancy, and chronic pelvic pain. Dollar values of each health outcome taken from listed sources.
§IM, intramuscular injection.
¶Cost of gonorrhea transmitted to female after initial female-to-male transmission. Calculated as a weighted average cost, weighted using the probabilities of onward transmission and the probabilities of occurrence of PID (only), infertility, ectopic pregnancy and chronic pelvic pain in the female (see Table 2 for probabilities). Costs of each outcome were taken from the listed sources.
#Cost of HIV in male patient after initial female-to-male transmission. Calculated as a weighted average cost, weighted by using the probabilities of onward transmission (see Table 2 for probabilities). Cost of a case of HIV is a weighted average cost, weighted by probabilities of HIV-related health outcomes, taken from listed sources.
1In 2000, only 18% of gonorrhea tests performed by public health laboratories in the United States were culture-based tests.
2Monte Carlo simulation involves specifying a probability distribution of values for model inputs. A computer algorithm then runs the model for several iterations. During each iteration, the computer algorithm selects input values from the probability distributions, and calculates the output (e.g., cost per patient successfully treated). After the final run, the model provides results such as the mean, median, and 5th and 95th percentiles for each specified output.