Cost-Effectiveness of the Surveillance Strategy for Antimicrobial-Resistant Gonorrhea in the United States: A Modelling Study

Background: The surveillance of antimicrobial-resistant (AMR) gonorrhea in the United States is conducted under the Gonococcal Isolate Surveillance Project (GISP). Its protocol involves the collection of urethral isolates from the symptomatic men diagnosed with urethral gonorrhea at designated surveillance sites and the estimation of the percentage of cases resistant to current and former gonorrhea antibiotics. A switch to a new antibiotic is typically made when this percentage for a current first-line drug reaches 5%. However, the cost-effectiveness of this surveillance strategy has never been assessed. Methods: We utilized our previously developed agent-based model of gonorrhea transmission among the US men who have sex with men (MSM) population and estimated the total number of gonorrhea cases, total number of discounted quality-adjusted life years (QALYs) and total discounted costs over 25 years under the current surveillance strategy and under a scenario with no surveillance. Results: The maintenance of the current surveillance strategy is projected to avert 104,108 (95% uncertainty interval: 9163, 213,238) gonorrhea cases, gain 192.9 (95% uncertainty interval: 6, 458.3) QALYs and save $38.6 million (95% uncertainty interval: $1 million, $68.2 million) in the simulated cohort of 10,000 US MSM over a 25-year period (2023–2048) when compared to a scenario with no surveillance. Conclusions: The current US surveillance strategy for AMR gonorrhea is cost-saving. However, the low-bound estimate indicates limited savings of $1 million, which is relatively modest at a national scale.