The cost-effectiveness of male-partner treatment to prevent recurrence of bacterial vaginosis

Bacterial vaginosis (BV) is a common vaginal condition with high recurrence after standard treatment. Male partners may serve as reservoirs for BV-associated bacteria. Randomised controlled trial (RCT) data show that adding male-partner treatment to standard female care reduces recurrence compared with female-only treatment. We assessed the economic viability of this approach. A cost-effectiveness analysis was conducted using decision-analytic models informed by RCT data. Country-specific models for Australia and South Africa represented high- and middle-income healthcare settings. Simulated cohorts of 10,000 women with symptomatic BV were followed over 12 months. Models incorporated recurrence, downstream complications (STIs, pelvic inflammatory disease, adverse pregnancy outcomes), healthcare costs, and quality-adjusted life-years (QALYs). Threshold analyses showed male-partner treatment became cost-saving at uptake ≥ 28.0% in Australia and ≥ 2.0% in South Africa. At base-case uptake (73%, based on observed partner participation in the trial extension), concurrent treatment reduced pregnancy complications (4,454 to 3,910), increased QALYs (0.89 to 0.92), and yielded substantial cost-savings (ICERs: -USD 24.6 M/QALY in Australia; -USD 43.0 M/QALY in South Africa). Cost-effectiveness improved with higher uptake. Main cost drivers were consultation, medication, and recurrent BV treatment in Australia, and preterm birth, low birthweight, and syndromic STI care in South Africa. Concurrent male-partner treatment reduces BV recurrence and is cost-saving, supporting updates to clinical guidelines and more efficient resource allocation.