Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia

ObjectivesMycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of testing strategies for MG using a healthcare provider perspective. MethodsWe used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: 1) no one tested; 2) symptomatic MSM; 3) symptomatic and high-risk asymptomatic MSM; 4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness to pay threshold of $30,000 AUD per QALY gained. We explored the impact of adding an AMR tax (i.e. additional cost per antibiotic consumed) to identify the threshold whereby any testing for MG is no longer cost-effective. ResultsTesting only symptomatic MSM is the most cost-effective (ICER $3,677 per QALY gained) approach. Offering testing to all men is dominated (i.e. not recommended because of higher costs and lower QALYs gained compared to other strategies). When the AMR tax was above $150, any testing for MG was no longer cost-effective. ConclusionTesting only symptomatic MSM is the most cost-effective option even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic consumed). For pathogens like MG where there are anticipated future costs related to AMR, we recommend models to test the impact of incorporating these costs as they can change the conclusions of cost-effectiveness studies. KEY MESSAGESO_LIWhat is already known on this topic - Mycoplasma genitalium (MG) is a sexually transmitted pathogen with rising antimicrobial resistance. C_LIO_LIWhat this study adds - This economic evaluation found that testing only symptomatic men who have sex with men (MSM) is the most cost-effective option. When the costs per antibiotic consumed is greater than $150, any testing for MG is no longer cost-effective. C_LIO_LIHow this study might affect research, practice or policy - Among testing strategies for MSM, testing for MG should be restricted to symptomatic men only. C_LI