Measuring the health benefits and costs of antimicrobial-resistant gonorrhea surveillance in the United States: an agent-based model and cost-effectiveness analysis

Background Antimicrobial resistant (AMR) gonorrhea poses an increasing threat to public health, yet evidence on the cost-effectiveness of surveillance systems that inform treatment policy is lacking. We assessed the long-term, population-level health benefits, costs, and cost-effectiveness of the Gonococcal Isolate Surveillance Project (GISP), the US national surveillance system for AMR gonorrhea. Methods We developed an agent-based model of gonococcal transmission among men who have sex with men to project gonorrhea-associated costs (healthcare sector perspective) and quality-adjusted life-years (QALYs) lost under GISP and three hypothetical scenarios in the absence of GISP: Randomized Treatment, Test-of-Cure, and a Combination strategy, representing a combination of clinical strategies for treating gonorrhea. Findings Over 20 years in a population of 100,000 men who have sex with men, all strategies resulted in similar overall gonorrhea incidence, but GISP achieved the lowest treatment failure incidence (1852 vs. 86,526, 144,063, and 119,258) and lowest AMR gonorrhea incidence (105,564 vs. 530,854, 631,123, and 575,309 infections). GISP resulted in lower costs and QALYs compared with each of the counterfactual strategies considered in our analysis. Interpretation Our findings highlight the health and economic benefits of GISP in controlling AMR gonorrhea and can be an efficient use of public health resources in the US. Additional studies are required to investigate the generalizability of our findings for other countries. Funding National Institutes of Health.