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Volume 11, Number 8—August 2005

Research

Optimizing Treatment of Antimicrobial-resistant Neisseria gonorrhoeae

Kakoli Roy*Comments to Author , Susan A. Wang*, and Martin I. Meltzer*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

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.

Main Article

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.

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