School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Sci Rep. 2024 Jun 4;14(1):12856. doi: 10.1038/s41598-024-63056-1.
The recommended first-line treatment for Mycoplasma genitalium infections is azithromycin. However, the prevalence of macrolide resistance for M. genitalium has increased to more than 50% worldwide. In 2013, Australia introduced a resistance-guided therapy (RGT) strategy to manage M. genitalium infections. This study assesses the cost-effectiveness of the RGT approach compared to no RGT (i.e., without macrolide resistance profile test) in women, men who have sex with men (MSM), and men who have sex with women (MSW) in Australia. We constructed dynamic transmission models of M. genitalium infections in women, MSM, and MSW in Australia, each with a population of 100,000. These models compared the costs and quality-adjusted life-years (QALYs) gained between RGT and no RGT scenarios from a healthcare perspective over ten years. All costs are reported in 2022 Australian dollars (Australian $). In our model, RGT is cost saving in women and MSM, with the incremental net monetary benefit of $1.3 million and $17.9 million, respectively. In MSW, the RGT approach is not cost-effective, with an incremental cost-effectiveness ratio of -$106.96 per QALY gained. RGT is cost saving compared to no RGT for M. genitalium infections in women and MSM, supporting its adoption as the national management strategy for these two population groups.
对于支原体属生殖器感染，推荐的一线治疗药物是阿奇霉素。然而，全球范围内支原体属生殖器对大环内酯类药物的耐药率已超过 50%。2013 年，澳大利亚引入了一种耐药指导治疗（RGT）策略来管理支原体属生殖器感染。本研究评估了 RGT 方法与无 RGT（即无大环内酯类药物耐药性检测）相比，在澳大利亚女性、男男性行为者（MSM）和男女性行为者（MSW）中的成本效益。我们构建了澳大利亚女性、MSM 和 MSW 中支原体属生殖器感染的动态传播模型，每个模型的人口均为 10 万。这些模型从医疗保健角度比较了 RGT 和无 RGT 方案在十年内的成本和质量调整生命年（QALY）获益。所有成本均以 2022 年澳大利亚元（澳元）报告。在我们的模型中，RGT 在女性和 MSM 中具有成本节约效果，分别有 130 万澳元和 1790 万澳元的增量净货币收益。在 MSW 中，RGT 方法不具有成本效益，增量成本效益比为每获得一个 QALY 损失 106.96 澳元。对于女性和 MSM 的支原体属生殖器感染，RGT 比无 RGT 更具有成本效益，支持将其作为这两个人群群体的国家管理策略。
