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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 4

Cost per case treated and percentage of treated cases without PID* on varying prevalence of gonorrhea and ciprofloxacin resistance (base-case values†)

Prevalence (%) gonorrhea‡ Strategy§ 0.1%
2%
10%
$/case treated¶ % cases with no PID¶ $/case treated % cases with no PID $/case treated % cases with no PID
1 ST1 26.00 99.92 26.03 99.92 26.17 99.92
ST2 32.76 99.93 32.85 99.93 33.20 99.92
ST3 26.21 99.92 26.21 99.92 26.21 99.92
ST4 34.07 99.93 34.07 99.93 34.07 99.93
5 ST1 42.04 99.61 42.20 99.60 42.89 99.60
ST2 45.70 99.65 46.11 99.64 47.87 99.61
ST3 41.92 99.61 41.92 99.61 41.92 99.61
ST4 47.12 99.65 47.12 99.65 47.12 99.65
10 ST1 62.09 99.21 62.41 99.21 63.79 99.18
ST2 61.86 99.30 62.70 99.29 66.21 99.22
ST3 61.55 99.21 61.55 99.21 61.55 99.21
ST4 63.42 99.31 63.42 99.31 63.42 99.31

*PID, pelvic inflammatory disease, which can cause sequelae such as chronic pelvic pain, infertility, and ectopic pregnancy.
†Baseline values given in Tables 2 and 3.
‡When gonorrhea prevalence is 1% and prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae is 0.1%, PID would not develop in 98.4% of patients treated. In the absence of any treatment, PID would not develop in 74% (range 60%–90%) of gonorrhea-infected women.
§Strategies modeled were ST1: ciprofloxacin + culture-based tests + ciprofloxacin-susceptibility tests; ST2: ciprofloxacin + nonculture-based tests; ST3: ceftriaxone + culture-based tests + ceftriaxone-susceptibility tests; ST4: ceftriaxone + nonculture-based tests. See Table 1 and text for further details.
¶Cost per patient treated and percentage of patients treated refer to all women who come to the public health clinic and undergo therapy as per 1 of the 4 strategies, regardless of actual infection.

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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