Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal

Phillips, Russell S.; Safran, Charles; Aronson, Mark D.; Taylor, William C.

doi:10.1016/0002-9343(89)90299-4

Cited by 11 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The breakeven cost was sensitive to the prevalence of ciprofloxacin susceptibility, the cost of standard of care, and the frequency of indeterminant gryA test findings, but insensitive to gonorrhoea prevalence (2% or 8%). A threshold gonorrhoea prevalence of 2.5% was reported by Phillips et al [ 31 ] for reducing the direct medical costs of gonorrhoea management in women when comparing routine gonorrhoea culture and susceptibility testing ($9 per culture test) with ‘no’ testing. However, the threshold prevalence was sensitive to the cost of culture tests and risk of adverse sequelae after treatment.…”

Section: Resultsmentioning

confidence: 99%

“…When AMR was defined in this manner it was often unclear what specific method (treatment failure or antibiotic susceptibility testing with minimum inhibitory concentration breakpoints) was used to establish resistance because AMR was frequently linked to published epidemiological estimates from sentinel surveillance programmes without providing additional detail. Other studies used gonorrhoea resistance specific genetic/molecular phenotypes such as mutant gyrA for ciprofloxacin resistance [ 12 , 39 , 40 ], 23SrRNA and mtrCDE for azithromycin resistance [ 39 ] or culture for penicillinase producing Neisseria gonorrhoeae [ 31 ] to define resistance.…”

Section: Resultsmentioning

confidence: 99%

“…Method of gonorrhoea AMR incorporation into the economic evaluation : The most common approach for incorporating AMR was to account for the additional cost of AMR testing and/or treatment [ 11 , 12 , 37 , 39 ]. Threshold analyses were also reported to identify the breakeven cost of using AMR POCT [ 40 ] and the threshold prevalence of gonorrhoea for using culture based testing [ 31 ]. Mostly, a baseline prevalence of resistance to certain drugs in a base case scenario was incorporated in the main model, and then altered in a sensitivity analysis [ 32 – 34 , 38 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Ayinde,

Ross,

Jackson

2023

PLoS ONE

View full text Add to dashboard Cite

Objective To provide a summary of the economic and methodological evidence on capturing antimicrobial resistance (AMR) associated costs for curable sexually transmitted infections (STIs). To explore approaches for incorporating the cost of AMR within an economic model evaluating different treatment strategies for gonorrhoea, as a case study. Methods A systematic review protocol was registered on PROSPERO (CRD42022298232). MEDLINE, EMBASE, CINAHL, Cochrane Library, International Health Technology Assessment Database, National Health Service Economic Evaluation Database, and EconLit databases were searched up to August 2022. Included studies were analysed, quality assessed and findings synthesised narratively. Additionally, an economic evaluation which incorporated AMR was undertaken using a decision tree model and primary data from a randomised clinical trial comparing gentamicin therapy with standard treatment (ceftriaxone). AMR was incorporated into the evaluation using three approaches—integrating the additional costs of treating resistant infections, conducting a threshold analysis, and accounting for the societal cost of resistance for the antibiotic consumed. Results Twelve studies were included in the systematic review with the majority focussed on AMR in gonorrhoea. The cost of ceftriaxone resistant gonorrhoea and the cost of ceftriaxone sparing strategies were significant and related to the direct medical costs from persistent gonorrhoea infections, sequelae of untreated infections, gonorrhoea attributable-HIV transmission and AMR testing. However, AMR definition, the collection and incorporation of AMR associated costs, and the perspectives adopted were inconsistent or limited. Using the review findings, different approaches were explored for incorporating AMR into an economic evaluation comparing gentamicin to ceftriaxone for gonorrhoea treatment. Although the initial analysis showed that ceftriaxone was the cheaper treatment, gentamicin became cost-neutral if the clinical efficacy of ceftriaxone reduced from 98% to 92%. By incorporating societal costs of antibiotic use, gentamicin became cost-neutral if the cost of ceftriaxone treatment increased from £4.60 to £8.44 per patient. Conclusions Inclusion of AMR into economic evaluations may substantially influence estimates of cost-effectiveness and affect subsequent treatment recommendations for gonorrhoea and other STIs. However, robust data on the cost of AMR and a standardised approach for conducting economic evaluations for STI treatment which incorporate AMR are lacking, and requires further developmental research.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Ayinde,

Ross,

Jackson

2023

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The effects were age and dose dependent. 4 These effects are characteristics of all quinolones and, although arthropathy has not been demonstrated in humans, children and pregnant women should not receive fluoroquinolone therapy.…”

Section: Metabolismmentioning

confidence: 99%

Quinolones for the Treatment of Neisseria Gonorrhoeae and Chlamydia Trachomatis

Faro

1993

Infectious Diseases in Obstetrics and Gynecology

View full text Add to dashboard Cite

The most commonly sexually transmitted bacteria are Neisseria gonorrhoeae and Chlamydia trachomatis. The quinolones ofloxacin and ciprofloxacin have been shown to have activity against both of these bacteria in vitro and in vivo. Ofloxacin is particularly well suited for the treatment of N. gonorrhoeae and C. trachomatis cervical infection, which can be considered the earliest manifestation of pelvic inflammatory disease (PID). Not only can ofloxacin be effectively used as a single agent, it is also useful in treating urinary tract infections caused by Enterobacteriaceae. Although it has moderate activity against anaerobes in general, ofloxacin does have activity against the anaerobes commonly isolated from female patients with soft tissue pelvic infections. Thus, ofloxacin has the potential for being utilized to treat early salpingitis.

show abstract

A new diagnostic index for predicting cervical infection with eitherChlamydia trachomatis orNeisseria gonorrhoeae

Rosenthal

Mettler²,

Pare³

et al. 1990

J Gen Intern Med

View full text Add to dashboard Cite

show abstract

Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal

Cited by 11 publications

References 20 publications

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Quinolones for the Treatment of Neisseria Gonorrhoeae and Chlamydia Trachomatis

A new diagnostic index for predicting cervical infection with eitherChlamydia trachomatis orNeisseria gonorrhoeae

Contact Info

Product

Resources

About