Cost-effectiveness of management strategies for acute urethritis in the developing world

OBJECTIVE To recommend a cost-effective approach for the management of acut e male urethritis in the developing world, based on the findings of a theor etical study. METHODS A model was developed to assess the cost-effectiveness of three ure thritis management strategies in a theoretical cohort of 1000 men with uret hral syndrome. (1) All patients were treated with cefixime and doxycycline for gonococcal urethritis (GU) and nongonococcal urethritis (NGU), respecti vely, as recommended by WHO. (2) All patients were treated with doxycycline for NGU; treatment with cefixime was based on the result of direct microsc opy of a urethral smear (3) All patients were treated with cotrimoxazole or kanamycin for GU and doxycycline for NGU. Cefixime was kept for patients n ot responding to the first GU treatment. Strategy costs included consultati ons, laboratory diagnosis (where applicable) and drugs. The outcome was the rate of patients cured of urethritis. Cost-effectiveness was measured in t erms of cost per cured urethritis. RESULTS Strategy costs in our model depended largely on drug costs. The fir st strategy was confirmed as the most effective but also the most expensive approach. Cefixime should cost no more than US$ 1.5 for the strategy to be the most cost-effective. The second strategy saved money and drugs but pro ved a valuable alternative only when laboratory performance was optimal. Th e third strategy with cotrimoxazole was the least expensive but a low follo w-up visit rate, poor treatment compliance or lower drug efficacy limited e ffectiveness. Maximizing compliance by replacing cotrimoxazole with single- dose kanamycin had the single greatest impact on the effectiveness of the t hird strategy. CONCLUSION Our model suggested that a cost-effective approach would be to t reat gonorrhoea with a single-dose antibiotic selected from locally availab le produces that cost no more than US$ 1.5.