Economic evaluation alongside a clinical trial of near-to-patient testing for sexually transmitted infections.

BACKGROUND: Current clinical care for common bacterial STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG)) involves empiric antimicrobial therapy when clients are symptomatic, or if asymptomatic, waiting for laboratory testing and recall if indicated. Near-to-patient testing (NPT) can improve pathogen-specific prescribing and reduce unnecessary or inappropriate antibiotic use in treating sexually transmitted infections (STI) by providing same-day delivery of results and treatment. METHODS: We compared the economic cost of NPT to current clinic practice for managing clients with suspected proctitis, non-gonococcal urethritis (NGU), or as an STI contact, from a health provider's perspective. With a microsimulation of 1000 clients, we calculated the cost per client tested and per STI- and pathogen- detected for each testing strategy. Sensitivity analyses were conducted to assess the robustness of the main outcomes. Costs are reported as Australian dollars (2023). RESULTS: In the standard care arm, cost per client tested for proctitis, NGU in men who have sex with men (MSM) and heterosexual men were the highest at $247.96 (95% Prediction Interval (PI): 246.77-249.15), $204.23 (95% PI: 202.70-205.75) and $195.01 (95% PI: 193.81-196.21) respectively. Comparatively, in the NPT arm, it costs $162.36 (95% PI: 161.43-163.28), $158.39 (95% PI: 157.62-159.15) and $149.17 (95% PI: 148.62-149.73), respectively. Using NPT resulted in cost savings of 34.52%, 22.45% and 23.51%, respectively. Among all the testing strategies, substantial difference in cost per client tested between the standard care arm and the NPT arm was observed for contacts of CT or NG, varying from 27.37% to 35.28%. CONCLUSION: We found that NPT is cost-saving compared with standard clinical care for individuals with STI symptoms and sexual contacts of CT, NG, and MG.

Cost-effectiveness of resistance-guided therapy for Mycoplasma genitalium in Australia.

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.

Pooling of urine samples for molecular detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium as a screening strategy among young adults in Catalonia / Pooling de muestras de orina para la detección molecular de Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium como estrategia de cribado entre la población joven en Cataluña

INTRODUCTION: Bacterial sexually transmitted infections (STIs) have an important impact on reproductive health, highlighting the increase in Chlamydia trachomatis infection rates among young people. To reduce the costs of STI detection, the pooling strategy is beneficial for high-throughput tests in low-prevalence populations using non-invasive samples. OBJECTIVES: (1) To describe the performance of a 7-STI PCR assay using the pooling of three urine samples to detect C. trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium; (2) to estimate the cost saving of the pooling strategy; (3) to describe the prevalence, risk factors and coinfections of C. trachomatis, N. gonorrhoeae and M. genitalium in young people ≤ 25 years in Catalonia. METHODS: cross-sectional prevalence study conducted in 2016 among young people ≤ 25 years of age seen in sexual and reproductive health centres throughout Catalonia from pools of three urine samples. A standardized questionnaire was used to collect clinical-epidemiological and behavioural variables. RESULTS: 1032 young people were tested. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium was 8.5%, 0.6% and 3.5%, respectively. The pooling strategy provided a 33% savings in reagent costs. CONCLUSIONS: The pooling strategy implemented for epidemiological studies in our context provides a savings that has an impact on the viability of STI detection programmes. In the same way, this study shows that C. trachomatis prevalence continues to increase in this population and, for the first time in Catalonia, the prevalence of M. genitalium in young people is shown

INTRODUCCIÓN: Las infecciones bacterianas de transmisión sexual (ITS) tienen un impacto importante en la salud reproductiva, destacando el aumento en las tasas de infección por Chlamydia trachomatis entre los jóvenes. Para reducir los costes de detección de las ITS, la estrategia de agrupación de muestras (pooling) es beneficiosa para pruebas de alto rendimiento en poblaciones de baja prevalencia utilizando muestras no invasivas. OBJETIVOS: 1) Describir el rendimiento de un ensayo de PCR 7-STI utilizando el pooling de 3 muestras de orina para detectar Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium; 2) Estimar el ahorro de la estrategia de pooling; 3) Describir la prevalencia, los factores de riesgo y las coinfecciones de Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium en jóvenes ≤ 25 años en Cataluña. MÉTODOS: Estudio transversal de prevalencia realizado durante 2016 entre jóvenes ≤ 25 años atendidos en centros de salud sexual y reproductiva en todo el territorio catalán a partir de pools de 3 muestras de orina. Se utilizó un cuestionario estandarizado para recopilar variables clínico-epidemiológicas y de comportamiento. RESULTADOS: Se testaron 1032 jóvenes. La prevalencia de Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium fue del 8,5, 0,6 y 3,5%, respectivamente. La estrategia de pooling proporcionó un ahorro del 33% en los costos de reactivo. CONCLUSIONES: La estrategia de pooling llevado a cabo para estudios epidemiológicos en nuestro contexto proporciona un ahorro que tiene un impacto en la viabilidad de los programas de detección de las ITS. De la misma manera, en este estudio se observa que la prevalencia de Chlamydia trachomatis continúa aumentando en esta población y, por primera vez en Cataluña, se determina la prevalencia de Mycoplasma genitalium en la población joven

Contagious agalactia: costs and control revisited.

The economic costs of contagious agalactia (CA) to the small ruminant dairy industry are not well known but include losses due to mortality, lowered milk production, spoiled products, abortions and animal welfare problems, as well as diagnosis and treatment. This paper reports financial estimates made in southern Europe, including a study on small- and large-scale farming systems in Italy, indicating that the financial losses are high and underestimated. Furthermore, the current control strategies, including chemotherapy and vaccination, in selected countries in Europe are described. In some countries, disease control is hampered by excessively strict veterinary legislation which discourages farmers and private veterinarians from notifying outbreaks because it leads to the prohibition of milk sales and can result in delays in lifting restrictions. In addition, new European Union legislation may downgrade the importance of CA, which will have implications for international research efforts. Finally, a series of recommendations are provided that cover the proper notification and handling of CA outbreaks, including movement control, current diagnostics, treatment, vaccination and disinfection.

Si le coût économique exact de l'agalaxie contagieuse pour le secteur ovin et caprin de production laitière n'est pas connu, on sait néanmoins qu'il recouvre les pertes dues à la mortalité dans les cheptels, à une chute de la production de lait, aux produits altérés, aux avortements et aux problèmes de bien-être animal, en plus des coûts du diagnostic et des traitements. Les auteurs font état d'estimations financières réalisées en Europe méridionale, dont une étude sur les exploitations familiales et les élevages de grande taille en Italie, qui coïncident dans le constat de pertes financières à la fois importantes et sous-estimées. Les auteurs décrivent également les stratégies de lutte mises en place actuellement par plusieurs pays d'Europe, en particulier l'antibiothérapie et la vaccination. Dans certains pays, les efforts de lutte sont entravés par une législation vétérinaire excessivement rigoureuse qui dissuade les éleveurs et les vétérinaires privés de notifier les foyers car cela entraîne l'interdiction de vendre le lait issu des troupeaux infectés et retarde la levée des mesures de restriction. En outre, la nouvelle réglementation de l'Union européenne risque d'abaisser l'importance de l'agalaxie contagieuse, ce qui aura des conséquences sur les efforts mobilisés par la recherche au niveau international. Pour conclure, les auteurs formulent plusieurs recommandations en vue d'une notification et gestion appropriées des foyers d'agalaxie contagieuse, notamment pour ce qui concerne le contrôle des mouvements d'animaux, les méthodes actuelles de diagnostic, le traitement, la vaccination et la désinfection.

Aunque no se conocen bien los costos económicos que la agalaxia contagiosa inflige a la industria lechera de pequeños rumiantes, se sabe que las pérdidas por mortalidad, mengua de la producción lechera, productos echados a perder, abortos y problemas de bienestar animal son un factor importante, sin olvidar los gastos de diagnóstico y tratamiento. Los autores dan cuenta de cálculos económicos realizados en Europa meridional, en particular a raíz de un estudio de pequeñas y grandes explotaciones ganaderas de Italia, que llevaron a la conclusión de que las pérdidas económicas son cuantiosas y están subestimadas. Además, los autores describen los métodos de lucha aplicados actualmente en determinados países de Europa, que incluyen tratamiento medicamentoso y vacunaciones. En algunos países la lucha contra la enfermedad se ve lastrada por una legislación veterinaria demasiado estricta, que no alienta a productores y veterinarios privados a notificar brotes porque ello conduce a la prohibición de las ventas de leche y puede demorar el levantamiento de las restricciones. Por otra parte, hay nuevos textos legislativos de la Unión Europea que quizá vengan a restar importancia a la agalaxia contagiosa, lo que repercutiría en las actividades internacionales de investigación. Por último, los autores formulan una serie de recomendaciones referidas a cuestiones que van desde la correcta notificación y gestión de los brotes de agalaxia contagiosa hasta el control de los desplazamientos, pasando por los procedimientos vigentes de diagnóstico o los métodos de tratamiento, vacunación y desinfección.

Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees.

OBJECTIVES: To quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing. DESIGN: Modelling study. SETTING: Genitourinary medicine (GUM) services in England. POPULATION: A hypothetical cohort of 965 988 people, representing the annual number attending GUM services symptomatic of lower genitourinary tract infection. INTERVENTIONS: The decision tree model considered costs and reimbursement to GUM services associated with diagnosing and managing STIs. Three strategies using hypothetical point-of-care tests (POCTs) were compared with standard care (SC) using laboratory-based testing. The strategies were: A) dual POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); B) triplex POCT for CT-NG and Mycoplasma genitalium (MG); C) quadruplex POCT for CT-NG-MG and Trichomonas vaginalis (TV). Data came from published literature and unpublished estimates. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were total costs and benefits (quality-adjusted life years (QALYs)) for each strategy (2016 GB, £) and associated incremental cost-effectiveness ratios (ICERs) between each of the POC strategies and SC. Secondary outcomes were inappropriate treatment of STIs, onward STI transmission, pelvic inflammatory disease in women, time to cure and total attendances. RESULTS: In the base-case analysis, POC strategy C, a quadruplex POCT, was the most cost-effective relative to the other strategies, with an ICER of £36 585 per QALY gained compared with SC when using microcosting, and cost-savings of £26 451 382 when using tariff costing. POC strategy C also generated the most benefits, with 240 467 fewer clinic attendances, 808 fewer onward STI transmissions and 235 135 averted inappropriate treatments compared with SC. CONCLUSIONS: Many benefits can be achieved by using multipathogen POCTs to improve STI diagnosis and management. Further evidence is needed on the underlying prevalence of STIs and SC delivery in the UK to reduce uncertainty in economic analyses.

Cost-effectiveness of microscopy of urethral smears for asymptomatic Mycoplasma genitalium urethritis in men in England.

The objective was to determine whether or not the limited use of urethral microscopy to diagnose asymptomatic and symptomatic non-chlamydial, non-gonococcal urethritis (NCNGU) in men is a cost-effective strategy to avert pelvic inflammatory disease (PID), ectopic pregnancy or infertility in female partners. Outputs from a transmission dynamic model of NCNGU in a population of 16-30 year olds in England simulating the number of consultations, PID cases and patients treated over time amongst others, were used along with secondary data to undertake a cost-effectiveness analysis carried out from a health care provider perspective. The main outcome measure was cost per case of PID averted. A secondary outcome measure was cost per major outcome averted, where a major outcome is a case of symptomatic PID, ectopic pregnancy, or infertility. Offering a limited number of asymptomatic men urethral microscopy was more effective than the current practice of no microscopy in terms of reducing the number of cases of PID with an incremental cost-effectiveness ratio of £15,700, meaning that an investment of £15,800 is required to avert one case of PID. For major outcomes averted, offering some asymptomatic men urethral microscopy was again found to be more effective than no microscopy, but here an investment of £49,900 is required to avert one major outcome. Testing asymptomatic men for NCNGU in a small number of genitourinary medicine settings in England is not cost-effective, and thus by maintaining the current practice of not offering this patient group microscopy, this continues to make savings for the health care provider.

Ornithobacterium rhinotracheale and Mycoplasma synoviae in broiler chickens in Jordan.

A cross-sectional study was conducted from November 2008 to July 2010 in commercial broiler flocks in southern (n = 50) and northern (n = 50) areas of Jordan, to determine the flock-level prevalence of Ornithobacterium rhinotracheale (ORT) and Mycoplasma synoviae (MS) infections. Tracheal swabs were collected from commercial broilers with respiratory disease and tested by polymerase chain reaction. In total, 21% (95% CI: 18-45%) and 25% (95% CI: 20-51%) of commercial broiler flocks were positive for ORT and MS, respectively. In the southern areas the prevalence of flocks with positive tracheal swabs for ORT and MS was 16% and 10%; in the northern areas the prevalence was 26% and 40%, respectively. Of the flocks tested, 7% were infected with ORT and MS simultaneously. Further epidemiological studies are recommended to determine risk factors and evaluate the economic consequences of ORT and MS infections in the region. Furthermore, studies are required to isolate ORT and MS and develop vaccines against the local field isolates.

[The importance of Mycoplasma bovis in bovine respiratory disease]. / Het belang van Mycoplasma bovis bij luchtwegaandoeningen van kalveren.

The annual damage caused by bovine respiratory disease is estimated at 45 up to 55 euro per calf of milking cattle and 117.50 euro per veal calf In Europe, M. bovis is responsible for at least 1/4 to 1/3 of all pneumonia cases in calves. Serology may help to identify the spreading of these bacteria in a herd.

Mycoplasma bovis: disease, diagnosis, and control.

Mycoplasma bovis is a major, but often overlooked, pathogen causing respiratory disease, mastitis, and arthritis in cattle. It is found worldwide and has spread into new areas, including Ireland and parts of South America, in the last decade. In Europe, it is responsible for at least a quarter to a third of all calf pneumonia although this may be an underestimate as few laboratories regularly monitor for mycoplasmas. Like all mollicutes, M. bovis is inherently refractory to certain groups of antibiotics because it does not possess a cell wall; furthermore evidence is accumulating that strains of M. bovis are becoming resistant to antibiotics, including tetracycline, tilmicosin and spectinomycin, traditionally used for their control. No vaccines are presently available for the control of M. bovis infections.

Mycoplasmal infections of cerebrospinal fluid in newborn infants from a community hospital population.

Mycoplasma hominis or Ureaplasma urealyticum have previously been isolated from cerebrospinal fluid (CSF) in 13 of 100 newborn infants tested from a high risk university hospital population where the mothers were of predominantly lower income and socioeconomic status and had often received little or no prenatal care. We sought to determine whether such infections occur in neonates born to women cared for mainly through private obstetric practices and who delivered in 4 suburban community hospitals. CSF cultures were done in 318 infants during an 8-month period. M. hominis was isolated from 9 and U. urealyticum from 5 CSF cultures. Four infants infected with U. urealyticum and 3 infected with M. hominis were born at term. One infant infected with U. urealyticum had a birth weight of less than 1000 g. In 5 infants clearance of the infecting organism was documented without specific treatment. Twelve infants had good perinatal outcomes regardless of treatment and 2 died. One death in a 2240-g infant infected with M. hominis was associated with Haemophilus influenzae sepsis and pneumonia. The other death occurred 3 days after birth in a 630-g infant infected with U. urealyticum who had evidence of meningitis and intraventricular hemorrhage. Results of this study suggest that mycoplasmas are common causes of neonatal CSF infections, not only in high risk populations, but also in the general population.

Economic impact of Mycoplasma gallisepticum and M. synoviae in commercial layer flocks.

An egg-production function was constructed, using data collected from 366 commercial layer flocks in California, to predict the impact of Mycoplasma gallisepticum (MG) and M. synoviae (MS) on egg production while controlling for confounding factors. In the first and second cycles, respectively, an MG-infected flock produced 12 and 5 fewer eggs per hen than an uninfected flock. Flocks that became infected with MG after F-strain vaccination produced 6 eggs/hen more than unvaccinated infected flocks in the first cycle, but no significant difference was observed between such groups in the second cycle. No association was found between MS-infection and egg production. Commercial layer producers in Southern California lost an estimated 127 million eggs because of MG in 1984. This lost egg production and associated MG-control-program costs amounted to an estimated financial loss of approximately $7 million. This represented a loss of approximately $6 million in consumer surplus.

An epornitic of Mycoplasma gallisepticum in turkeys.

A major epornitic of Mycoplasma gallisepticum occurred in the Monroe, North Carolina, area between January and June of 1983. The outbreak involved 304,000 turkeys of various ages, which were slaughtered in the eradication program at a cost of more than $550,000 to growers and poultry companies. An infected peafowl was the likely source of infection on the first farm. Traffic between farms by growers and company personnel was theorized to be the means of further spread.

Formulating a control program against Mycoplasma meleagridis using economic decision analysis.

Economic decision analysis was applied to a variety of programs for controlling Mycoplasma meleagridis (MM) using a hypothetical commercial turkey multiplier breeder as an example. The analysis demonstrated the economic significance of a particular program for controlling MM and reevaluated current egg-dipping practices. If forced to continue egg-dipping, the hypothetical breeder can expect to gain $1.58 per hen if he follows a MM-control program that includes monitoring and incentive payments. If he can discontinue dipping, he can expect a gain of $2.06 per hen.