Cost-effective treatment of uncomplicated gonorrhoea including co-infection with Chlamydia trachomatis Genc M, Mardh P A

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1 Cost-effective treatment of uncomplicated gonorrhoea including co-infection with Chlamydia trachomatis Genc M, Mardh P A Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Treatment of uncomplicated gonorrhoea with either intramuscular ceftriaxone or a single oral dose of cefixime, ofloxacin or ciprofloxacin, combined with empirical antichlamydial therapy with either a single oral dose of azithromycin, or oral doxycycline in adults (non-pregnant women of reproductive age, and men) with a laboratoryconfirmed diagnosis of uncomplicated gonorrhoea. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Adults (non-pregnant women of reproductive age, and men) with a laboratory-confirmed diagnosis of uncomplicated gonorrhoea. Setting Clinic. The economic study was conducted in Sweden. Dates to which data relate Effectiveness data (percentage cured) were reported from trials after 1980 based on two papers published in 1995 and Clinical probabilities were reported from the literature published between 1975 and No distinction was made between resource use data and cost data. The fiscal year was Source of effectiveness data Effectiveness data were derived from a review of the literature. Modelling A decision analysis model was used to estimate the cost-effectiveness of alternative strategies. Outcomes assessed in the review The review assessed efficacy as measured by the percentage of patients cured due to single-dose antimicrobial regimens for the treatment of uncomplicated gonococcal infections. The clinical probabilities assessed were the proportion of infected women seeking medical care for symptomatic cervicitis and acute pelvic inflammatory disease (PID), the proportion of hospitalised patients with PID, the infertility rate in patients with PID, ectopic pregnancy rate in patients Page: 1 / 5

2 with PID, the proportion of patients with PID experiencing chronic pelvic pain, the birth rate for infected women, the percentage of neonates borne by mothers with gonorrhoea developing ophthalmia neonatorum, and the proportion of infected men seeking medical care for symptomatic urethritis. Study designs and other criteria for inclusion in the review Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Number of primary studies included A total of 8 studies were included in the review. Methods of combining primary studies Investigation of differences between primary studies Results of the review The percentage cured (95% confidence intervals) was reported to be: intramuscular ceftriaxone 125mg for single urogenital or rectal site (SS), ; intramuscular ceftriaxone 125mg for pharynx, ; intramuscular ceftriaxone 125mg for multiple or unspecified sites, The rates for the remaining drugs considered in the study, according to the type of site were as follows: cefixime 400mg, (SS), (PH), (MU); ofloxacin 400mg, (SS), (PH), (MU); ciprofloxacin 500mg, (SS), (PH); azithromycin 1g, (SS), (PH), and (MU). The values adopted for the clinical probabilities were as follows: proportion of infected women seeking medical care for symptomatic cervicitis were 20% to 80%; Page: 2 / 5

3 proportion seeking care for acute pelvic inflammatory disease (PID), 10 to 23%; proportion of hospitalised patients with PID, 12 to 25%; infertility rate in patients with PID, 10 to 20%; ectopic pregnancy rate in patients with PID, 4 to 6%; proportion of patients with PID experiencing chronic pelvic pain, 17 to 18%; birth rate for infected women, 3 to 6%; percentage of neonates borne by mothers with gonorrhoea developing ophthalmia neonatorum, 2 to 30%; proportion of infected men seeking medical care for symptomatic urethritis, 50 to 90%. Measure of benefits used in the economic analysis The benefit measure was efficacy as measured by the percentage of patients cured. Direct costs Costs were discounted. Quantities and costs were not reported separately. Hospital costs related to medical services, including the salaries of healthcare personnel and costs of hospitals, drugs, equipment, costs of adverse effects, etc, and the cost of untreated gonorrhoea. The perspective adopted in the cost analysis was that of society. The costs estimates were based on average salaries and cost of medical care in Sweden, based on published studies. The price data referred to Indirect Costs Indirect costs were discounted. Quantities and costs were not reported separately. Indirect costs comprised lost wages and lost value of household management due to participation in a healthcare programme or sickness price data were used. Currency Swedish kroner (SEK). Approximate exchange rate: SEK1 = US$7. Sensitivity analysis Besides choosing the input values randomly from the defined ranges, sensitivity and threshold analyses were carried out varying the rate of compliance, prevalence of chlamydial infection, the cost of azithromycin, and indirect cost. Estimated benefits used in the economic analysis The percentage cured (95% confidence intervals) was reported to be: intramuscular ceftriaxone 125mg for single urogenital or rectal site (SS), ; intramuscular ceftriaxone 125mg for pharynx, ; intramuscular ceftriaxone 125mg for multiple or unspecified sites, The rates for the remaining drugs considered in the study, according to the type of the site (SS, PH, or MU), were as follows: cefixime 400mg, (SS), (PH), (MU); Page: 3 / 5

4 ofloxacin 400mg, (SS), (PH), (MU); ciprofloxacin 500mg, (SS), (PH); azithromycin 1g, (SS), (PH), and (MU). Cost results Costs were discounted at 5 to 10%. The average total costs of the alternative strategies were not reported. Synthesis of costs and benefits The average cost per cured patient was calculated as the measure of synthesis of cost and benefit. Treatment of gonorrhoea with ceftriaxone was more cost-effective than a single oral dose of cefixime 400mg, ofloxacin 400mg and ciprofloxacin 500mg. This was followed by either ofloxacin or ciprofloxacin, then cefixime. For empirical treatment of uncomplicated chlamydial infection, doxycycline was more cost effective than azithromycin when the compliance rate was more than 80%. The results were unaffected if 1g of azithromycin cost less than US$5. Authors' conclusions Treatment of gonorrhoea with intramuscular ceftriaxone combined with empirical antichlamydial therapy with oral doxycycline 100mg twice daily for 7 days was the most cost-effective alternative. CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator is clear. Validity of estimate of measure of benefit The internal validity of the estimates of effectiveness can not be guaranteed given the lack of detail regarding the literature review, and quality assessment of the primary studies included in the review. Validity of estimate of costs Resource use data were not reported separately from the costs. However, adequate details of methods of cost estimation were given. Other issues More details of the results of cost, benefit, and cost-effectiveness analysis would have been useful. Source of funding None stated Bibliographic details Genc M, Mardh P A. Cost-effective treatment of uncomplicated gonorrhoea including co-infection with Chlamydia trachomatis. PharmacoEconomics 1997; 12(3): PubMedID Indexing Status Subject indexing assigned by NLM Page: 4 / 5

5 Powered by TCPDF ( MeSH Adult; Anti-Bacterial Agents /economics /therapeutic use; Chlamydia Infections /complications /drug therapy /economics; Chlamydia trachomatis; Cost-Benefit Analysis; Female; Gonorrhea /complications /drug therapy /economics; Humans; Male AccessionNumber Date bibliographic record published 31/05/2000 Date abstract record published 31/05/2000 Page: 5 / 5