Abstract：
OBJECTIVE: Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective.
METHODS: We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective.
RESULTS: Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective.
CONCLUSIONS: Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
METHODS: We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective.
RESULTS: Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective.
CONCLUSIONS: Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
摘要：
目的：生殖道支原体（MG）不成比例地影响男男性行为者（MSM）。我们确定了MSM中MG不同测试策略的成本效益，从医疗保健提供者的角度来看。
方法：我们在决策树模型中使用了居住在澳大利亚的MSM之间MG动态传播模型的输入，以评估四种测试方案对MG发病率的影响：（1）没有人测试；（2）有症状的MSM；（3）有症状的和高风险的无症状的MSM；（4）所有MSM。我们使用获得的每个质量调整生命年（QALY）的支付意愿阈值A30000美元来计算增量成本效益比（ICER）。我们探讨了增加抗菌素耐药性(AMR)税的影响(即，每个抗生素消耗的额外成本)来确定阈值，因此，对MG的任何测试都不再具有成本效益。
结果：仅测试有症状的MSM是最具成本效益的方法（ICER$3677/QALY）。向所有MSM提供测试是主导的(即，与其他策略相比，获得了更高的成本和更低的QALY)。当每种抗生素的AMR税超过150美元时，对MG的任何测试都不再具有成本效益。
结论：仅测试有症状的MSM是最具成本效益的选择，即使考虑到与AMR相关的潜在成本(每个抗生素的额外成本高达150美元).对于像MG这样的病原体，如果存在与AMR相关的预期未来成本，我们推荐一些模型来测试纳入AMR税的影响,因为这些模型可以改变成本效益研究的结果和结论.
方法：我们在决策树模型中使用了居住在澳大利亚的MSM之间MG动态传播模型的输入，以评估四种测试方案对MG发病率的影响：（1）没有人测试；（2）有症状的MSM；（3）有症状的和高风险的无症状的MSM；（4）所有MSM。我们使用获得的每个质量调整生命年（QALY）的支付意愿阈值A30000美元来计算增量成本效益比（ICER）。我们探讨了增加抗菌素耐药性(AMR)税的影响(即，每个抗生素消耗的额外成本)来确定阈值，因此，对MG的任何测试都不再具有成本效益。
结果：仅测试有症状的MSM是最具成本效益的方法（ICER$3677/QALY）。向所有MSM提供测试是主导的(即，与其他策略相比，获得了更高的成本和更低的QALY)。当每种抗生素的AMR税超过150美元时，对MG的任何测试都不再具有成本效益。
结论：仅测试有症状的MSM是最具成本效益的选择，即使考虑到与AMR相关的潜在成本(每个抗生素的额外成本高达150美元).对于像MG这样的病原体，如果存在与AMR相关的预期未来成本，我们推荐一些模型来测试纳入AMR税的影响,因为这些模型可以改变成本效益研究的结果和结论.
