Figure 2.

Simulations of gonorrhoea transmission over time in MSM in England, under different vaccination strategies

Simulations are based on use of a vaccine providing 40% protection for 4 years, with vaccine uptake at the level of HPV vaccine uptake by MSM in sexual health clinics in England (ie, 33·0% [95% CI 32·7–33·3]). (A) Annual gonorrhoea diagnoses (note that the lines for the VaR and VoA strategies almost overlap). (B) Annual vaccine doses administered. (C) Cumulative value of vaccination per dose administered in sexual health clinics; note that there is no value calculated for the VbE strategy because we conducted the analysis taking the perspective of sexual health clinics and VbE is not provided by sexual health clinics. For panels A–C, lines represent medians and shaded regions represent 95% credible intervals. Note that panels A and B show undiscounted numbers while panel C shows discounted £ values. (D) Probability that each strategy is the most cost-effective over 20 years for vaccines ranging in efficacy (1–100%) and duration of protection (1–20 years); in all cases, either VoD or VaR is the most cost-effective strategy, and the dashed contour line shows where the two strategies have equal probability of being the most cost-effective, while the solid contour lines show where either the VoD strategy (upper right) or the VaR strategy (lower left) has a 95% probability of being the most cost-effective. MSM=men who have sex with men. VbE=vaccination before entry. VoD=vaccination on diagnosis. VaR=vaccination according to risk. VoA=vaccination on attendance.