Modeling the Cost-Effectiveness of Express Multisite Gonorrhea Screening Among Men Who Have Sex With Men in the United States. Issue 11 (7th November 2021)

• Record Type: Journal Article
• Authors: Earnest, Rebecca; Rönn, Minttu M.; Bellerose, Meghan; Menon-Johansson, Anatole S.; Berruti, Andrés A.; Chesson, Harrell W.; Gift, Thomas L.; Hsu, Katherine K.; Testa, Christian; Zhu, Lin; Malyuta, Yelena; Menzies, Nicolas A.; Salomon, Joshua A.
• Is Part Of: Sexually transmitted diseases. Volume 48:Issue 11(2021)
• Page Start: 805
• Page End: 812
• Publication Date: 2021-11-07
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001467
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : An agent-based model of multisite gonorrhea transmission among urban US men who have sex with men found that express screening may be a cost-effective option for improving multisite anatomic screening. Supplemental digital content is available in the text. Abstract : Background: Men who have sex with men (MSM) experience high rates of gonococcal infection at extragenital (rectal and pharyngeal) anatomic sites, which often are missed without asymptomatic screening and may be important for onward transmission. Implementing an express pathway for asymptomatic MSM seeking routine screening at their clinic may be a cost-effective way to improve extragenital screening by allowing patients to be screened at more anatomic sites through a streamlined, less costly process. Methods: We modified an agent-based model of anatomic site-specific gonococcal infection in US MSM to assess the cost-effectiveness of an express screening pathway in which all asymptomatic MSM presenting at their clinic were screened at the urogenital, rectal, and pharyngeal sites but forewent a provider consultation and physical examination and self-collected their own samples. We calculated the cumulative health effects expressed as gonococcal infections and cases averted over 5 years, labor and material costs, and incremental cost-effectiveness ratios for express versus traditional scenarios. Results: The express scenario averted more infections and cases in each intervention year. The increased diagnostic costs of triple-site screening were largely offset by the lowered visit costs of the express pathway and, from the end of year 3 onward, this pathway generated small cost savings. However, in a sensitivity analysis of assumed overhead costs, cost savings under the express scenario disappeared in the majority of simulations once overhead costs exceeded 7% of total annual costs. Conclusions: Express screening may be a cost-effective option for improving multisite anatomic screening among US MSM.