Sexual Health and HIV, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom.
Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2023 Oct 19;18(10):e0292273. doi: 10.1371/journal.pone.0292273. eCollection 2023.
To provide a summary of the economic and methodological evidence on capturing antimicrobial resistance (AMR) associated costs for curable sexually transmitted infections (STIs). To explore approaches for incorporating the cost of AMR within an economic model evaluating different treatment strategies for gonorrhoea, as a case study.
A systematic review protocol was registered on PROSPERO (CRD42022298232). MEDLINE, EMBASE, CINAHL, Cochrane Library, International Health Technology Assessment Database, National Health Service Economic Evaluation Database, and EconLit databases were searched up to August 2022. Included studies were analysed, quality assessed and findings synthesised narratively. Additionally, an economic evaluation which incorporated AMR was undertaken using a decision tree model and primary data from a randomised clinical trial comparing gentamicin therapy with standard treatment (ceftriaxone). AMR was incorporated into the evaluation using three approaches-integrating the additional costs of treating resistant infections, conducting a threshold analysis, and accounting for the societal cost of resistance for the antibiotic consumed.
Twelve studies were included in the systematic review with the majority focussed on AMR in gonorrhoea. The cost of ceftriaxone resistant gonorrhoea and the cost of ceftriaxone sparing strategies were significant and related to the direct medical costs from persistent gonorrhoea infections, sequelae of untreated infections, gonorrhoea attributable-HIV transmission and AMR testing. However, AMR definition, the collection and incorporation of AMR associated costs, and the perspectives adopted were inconsistent or limited. Using the review findings, different approaches were explored for incorporating AMR into an economic evaluation comparing gentamicin to ceftriaxone for gonorrhoea treatment. Although the initial analysis showed that ceftriaxone was the cheaper treatment, gentamicin became cost-neutral if the clinical efficacy of ceftriaxone reduced from 98% to 92%. By incorporating societal costs of antibiotic use, gentamicin became cost-neutral if the cost of ceftriaxone treatment increased from £4.60 to £8.44 per patient.
Inclusion of AMR into economic evaluations may substantially influence estimates of cost-effectiveness and affect subsequent treatment recommendations for gonorrhoea and other STIs. However, robust data on the cost of AMR and a standardised approach for conducting economic evaluations for STI treatment which incorporate AMR are lacking, and requires further developmental research.
总结可治愈性性传播感染（STI）中与抗生素耐药性（AMR）相关成本的经济和方法学证据。以淋病为例，探讨在评估不同治疗策略的经济模型中纳入 AMR 成本的方法。
在 PROSPERO（CRD42022298232）上注册了系统评价方案。检索了 MEDLINE、EMBASE、CINAHL、Cochrane 图书馆、国际卫生技术评估数据库、英国国家卫生服务经济评价数据库和 EconLit 数据库，检索截至 2022 年 8 月。对纳入的研究进行分析、质量评估和叙述性综合。此外，使用来自比较庆大霉素治疗与标准治疗（头孢曲松）的随机临床试验的初级数据，通过决策树模型进行了一项纳入 AMR 的经济评估。通过三种方法将 AMR 纳入评估 - 整合治疗耐药感染的额外成本、进行阈值分析以及核算抗生素消耗的社会耐药成本。
系统评价纳入了 12 项研究，其中大多数研究集中在淋病中的 AMR。头孢曲松耐药淋病的成本和头孢曲松节约策略的成本与持续性淋病感染的直接医疗成本、未治疗感染的后果、淋病归因于 HIV 传播和 AMR 检测有关。然而，AMR 定义、AMR 相关成本的收集和纳入以及所采用的观点不一致或有限。利用审查结果，探索了将 AMR 纳入比较庆大霉素与头孢曲松治疗淋病的经济评估的不同方法。虽然最初的分析表明头孢曲松是更便宜的治疗方法，但如果头孢曲松的临床疗效从 98%降至 92%，庆大霉素的治疗成本则保持不变。如果头孢曲松治疗的成本从每位患者 4.60 英镑增加到 8.44 英镑，那么将抗生素使用的社会成本纳入其中，庆大霉素的治疗成本也将保持不变。
将 AMR 纳入经济评估可能会极大地影响成本效益的估计，并影响随后对淋病和其他 STI 的治疗建议。然而，目前缺乏 AMR 成本的可靠数据和纳入 AMR 的 STI 治疗经济评估的标准化方法，需要进一步的发展研究。
