Table 3. Cost parameters used in the model for antimicrobial point-of-care test strategies.
| Cost input | Costa | Comments and references | |
|---|---|---|---|
| Base case value | Range (low–high) | ||
| Management of NG (oral medication/IM injection) | GBP 53.00/ GBP 62.74 (EUR 70.88 / EUR 83.90) |
GBP 37.10–68.90 / GBP 43.92–81.56 (EUR 49.6–92.1 / EUR 58.73–109.07) |
bAdapted from previous model. Adams, 2014 [30] |
| Return visit due to treatment failure | GBP 48.01 (EUR 64.20) |
GBP 33.61–62.41 (EUR 44.95–83.46) |
b,c Adapted from previous model. Adams, 2014 [30] |
| Single AMR POCT | GBP 29.00 (EUR 38.78) |
GBP 20.00–40.00 (EUR 26.75–53.49) |
Estimate [47] |
| Dual AMR POCT | GBP 31.90 (EUR 42.66) |
GBP 29.00–58.00 (EUR 38.78–77.56) |
Estimate – 10% more than price of single AMR POCT (multiplier 1.1, range 1.0–2.0) |
| Dual AMR POCT | GBP 31.90 (EUR 42.66) |
GBP 22.00–44.00 (EUR 29.42–58.84) |
Estimate – single AMR POCT is varied, multiplier remains at 1.1 (10% more than price of single AMR POCT) |
| Azithromycin 1 gd | GBP 1.16 (EUR 1.55) |
GBP 0.81–1.51 (EUR 1.08–2.02) |
BNF, 2016 [34] |
| Azithromycin 2 gd | GBP 2.32 (EUR 3.10) |
GBP 1.62–3.02 (EUR 2.17–4.04) |
BNF, 2016 [34] |
| Ceftriaxone 500 mg e | GBP 9.58 (EUR 12.81) |
GBP 6.71–12.45 (EUR 8.97–16.65) |
BNF, 2016 [34] |
| Ciprofloxacin 500 mgd | GBP 0.07 (EUR 0.09) |
GBP 0.05–0.09 (EUR 0.07–0.12) |
BNF, 2016 [34] |
AMR: antimicrobial resistance; BNF: British National Formulary; IM: intramuscular; NG: Neisseria gonorrhoeae; POCT: point-of-care test.
a GBP costs were converted to EUR using a historic currency conversion of an average of 366 days from 1 July 2015 to 30 June 2016 [48]. For this time period, GBP 1 = EUR 1.34, and EUR 1 = GBP 0.75.
b Includes staff time and consumables but not antibiotic costs. Costs were inflated to 2015/16 costs using the Hospital and Community Health Services (HCHS) Inflation Indices 2015 produced by the Personal Social Services Research Unit [33]. No data were available for inflation from 2014/15 to 2015/16 so it was assumed to be the same as between 2013/2014 and 2014/15. The United Kingdom hospital consumer price index for health services shows similar annual growth in this sector from 2014 (93.2 in 2013, 97.1 in 2014 and 100 in 2015), which validates this assumption [49]. GBP costs were converted to EUR using a historic currency conversion of an average of 366 days from 1 July 2015 to 30 June 2016 [48]. For this time period, GBP 1 = EUR 1.34, and EUR 1 = GBP 0.75. A further breakdown of cost data are provided in Supplementary Table S3.
c Within the context of this model, treatment failure due to resistance to a monotherapy would result in a return visit. No repeat culture would be taken and no repeat diagnostic tests would occur. The patient would be successfully treated using ceftriaxone, administered via injection.
d Oral medication.
e Administered via intramuscular injection. The price quoted is for 1 g vial of ceftriaxone, the smallest non-proprietary vial available [34] - the remaining 500 mg is then discarded.