Personalization of therapy for infections caused by N. gonorrhoeae, C. trachomatis, M. genitalium, and T. vaginalis. Part III. Assessment of pharmacoeconomic effectiveness of personalized therapy

Background. Pharmacoeconomic studies serve as a scientific basis for optimizing healthcare delivery and assessing the economic feasibility of various therapeutic approaches. Objective. To perform a comparative assessment of the pharmacoeconomic effectiveness of treating patients with uncomplicated gonococcal, chlamydial, and M. genitalium (MG) infections as well as trichomoniasis, according to either a personalized algorithm (PA) or clinical guidelines (CGs). Materials and methods. Patients (n=508) with uncomplicated gonococcal (n=175), chlamydial (n=195), and MG (n=111) infections, as well as trichomoniasis (n=27), received outpatient treatment at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology (MSPCDC) in 2024. Group 1 included 286 patients who underwent treatment according to the PA depending on the concentration of pathogen DNA in the urogenital tract (UGT): higher doses and longer courses of antimicrobial agents for high pathogen DNA concentrations (>104 GE/mL), and lower doses and shorter courses for low DNA concentrations (<104 GE/mL). Patients in Group 2 (n=222) were treated in accordance with the 2024 CGs (without regard to pathogen DNA concentration in the urogenital tract). The DNA was analyzed using real-time PCR. Cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER) were used to evaluate treatment and associated costs. Results. It was established that the PA of therapy, which is based on DNA concentration levels in UGT samples, was both clinically and economically more effective than the approach according to the CGs for gonococcal, chlamydial, and MG infections. The CER values for therapy using the PA were lower than those for treatment according to the CGs (37.8 vs. 38.5 for gonococcal infection, 36.7 vs. 42.6 for chlamydial infection, and 44.1 vs. 66.3 for MG infection), demonstrating the economic efficiency of the proposed PA, given that the treatment regimen with the lowest CER value is economically preferable. For chlamydial and MG infections, the PA-based strategy proved to be both less costly and more effective than the CG-based one (ICER: –77.4 for C. trachomatis and –104.08 for MG infection). No pharmacoeconomic benefits were demonstrated for the treatment of uncomplicated trichomoniasis using the PA. Conclusion. The PA, which considers DNA concentrations in the UGT, was found to offer a pharmacoeconomic advantage over standard therapy based on CGs. This advantage was most pronounced in cases of chlamydial and MG infections.