{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T15:08:21Z","timestamp":1771340901394,"version":"3.50.1"},"reference-count":23,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2018,7,24]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To assess the cost-effectiveness of three testing strategies with or without light microscopic Gram-stained smear (GSS) evaluation for the detection of anogenital gonorrhoea among men who have sex with men (MSM) at the Amsterdam STI clinic using a healthcare payer perspective.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Three testing strategies for MSM were compared: (1) GSS in symptomatic MSM only (currently practised strategy), (2) no GSS and (3) GSS in symptomatic and asymptomatic MSM. The three testing protocols include testing with nucleic acid amplification test to verify the GSS results in (1) and (3), or as the only test in (2). A transmission model was employed to calculate the influence of the testing strategies on the prevalence of anogenital gonorrhoea over 10 years. An economic model combined cost data on medical consultations, tests and treatment and utility data to estimate the number of epididymitis cases and quality-adjusted life years (QALY) associated with gonorrhoea. Incremental cost-effectiveness ratios (ICERs) for the testing scenarios were estimated. Uncertainty and sensitivity analyses were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>No GSS testing compared with GSS in symptomatic MSM only (current strategy) resulted in nine extra epididymitis cases (95% uncertainty interval (UI): 2\u201322), 72 QALYs lost (95% UI: 59\u2013187) and \u20ac7300 additional costs (95% UI: \u2212\u20ac185 000 (i.e.cost-saving) to \u20ac407 000) over 10 years. GSS testing in both symptomatic and asymptomatic MSM compared with GSS in symptomatic MSM only resulted in one prevented epididymitis case (95% UI: 0\u20132), 1.1 QALY gained (95% UI: 0.1\u20133.3), \u20ac148 000 additional costs (95% UI: \u20ac86 000 to\u2013\u20ac217 000) and an ICER of \u20ac177 000 (95% UI: \u20ac67 000\u2013to \u20ac705 000) per QALY gained over 10 years. The results were robust in sensitivity analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>GSS for symptomatic MSM only is cost-effective compared with no GSS for MSM and with GSS for both symptomatic and asymptomatic MSM.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/sextrans-2018-053578","type":"journal-article","created":{"date-parts":[[2018,9,8]],"date-time":"2018-09-08T16:19:30Z","timestamp":1536423570000},"page":"13-20","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Microscopic examination of Gram-stained smears for anogenital gonorrhoea in men who have sex with men is cost-effective: evidence from a modelling study"],"prefix":"10.1136","volume":"95","author":[{"given":"Jolijn M","family":"Zwart","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8914-2045","authenticated-orcid":false,"given":"Marie-Josee J","family":"Mangen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menne","family":"Bartelsman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martijn S","family":"van Rooijen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry J C","family":"de Vries","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Xiridou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,9,8]]},"reference":[{"key":"2024092304402204000_95.1.13.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0143304","article-title":"Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting","volume":"10","author":"Newman","year":"2015","journal-title":"PLoS One"},{"key":"2024092304402204000_95.1.13.2","doi-asserted-by":"publisher","DOI":"10.1177\/0956462412472837"},{"key":"2024092304402204000_95.1.13.3","unstructured":"Visser M , van Aar F , van Oeffelen AAM . Sexually transmitted infections including HIV, in The Netherlands in 2016. Bilthoven: National Institute of Public Health and the Environment, 2017."},{"key":"2024092304402204000_95.1.13.4","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051500"},{"key":"2024092304402204000_95.1.13.5","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2017-053159"},{"key":"2024092304402204000_95.1.13.6","first-page":"450","article-title":"NHG-Standaard Het soa-consult","volume":"56","author":"Van Bergen","year":"2013","journal-title":"Huisarts Wet"},{"key":"2024092304402204000_95.1.13.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro1562"},{"key":"2024092304402204000_95.1.13.8","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e318284e544"},{"key":"2024092304402204000_95.1.13.9","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200005010-00009"},{"key":"2024092304402204000_95.1.13.10","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318195bd2b"},{"key":"2024092304402204000_95.1.13.11","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051147"},{"key":"2024092304402204000_95.1.13.12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/4386127","article-title":"A systematic review of point of care testing for chlamydia trachomatis, neisseria gonorrhoeae, and trichomonas vaginalis","volume":"2016","author":"Herbst de Cortina","year":"2016","journal-title":"Infect Dis Obstet Gynecol"},{"key":"2024092304402204000_95.1.13.13","unstructured":"2015 Sexually transmitted diseases treatment guidelines centers for disease control and prevention. https:\/\/www.cdc.gov\/std\/tg2015\/gonorrhea.htm (accessed 20 Jun 2017)."},{"key":"2024092304402204000_95.1.13.14","unstructured":"Institute of Medicine. Vaccines for the 21st century: A tool for decis ionmaking. Washington, DC: National Academy Press, 2000."},{"key":"2024092304402204000_95.1.13.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2005.07.003"},{"key":"2024092304402204000_95.1.13.16","unstructured":"Medicijnkosten. Diemen: zorginstituut Nederland. http:\/\/www.medicijnkosten.nl\/"},{"key":"2024092304402204000_95.1.13.17","unstructured":"Hakkaart-van Roijen LVdL , Bouwmans N , Kanters C . Richtlijn voor het uitvoeren vaneconomische evaluaties in de gezondheidszorg (verdiepingsmodules) \u2013 BIJLAGE 1 -Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economischeevaluaties in de gezondheidszorg. Diemen: Zorginstituut Nederland, 2015."},{"key":"2024092304402204000_95.1.13.18","unstructured":"Statistic Netherlands. Consumentenprijzen; prijsindex. Den Haag\/Heerlen: Centraal Bureau voor de Statistiek, 2017."},{"key":"2024092304402204000_95.1.13.19","unstructured":"Tan-Torres Edejer T , Baltussen R , Adam T . Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization, 2003."},{"key":"2024092304402204000_95.1.13.20","unstructured":"Statistic Ne therlands. Regional key figures, national accounts. Den Haag\/Heerlen: Centraal Bureau voor de Statistiek, 2017."},{"key":"2024092304402204000_95.1.13.21","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200005000-00001"},{"key":"2024092304402204000_95.1.13.22","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000175395.95911.85"},{"key":"2024092304402204000_95.1.13.23","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jir400"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2018-053578","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T17:56:42Z","timestamp":1727114202000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2018-053578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,8]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,23]]},"published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1136\/sextrans-2018-053578"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2018-053578","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,8]]}}}