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Int J STD AIDS. 2018 Jan;29(1):72-79. doi: 10.1177/0956462417717651. Epub 2017 Jul 1.

Cost-effectiveness of microscopy of urethral smears for asymptomatic Mycoplasma genitalium urethritis in men in England.

Author information

1 Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
2 NIHR Diagnostic Evidence Co-operative Leeds, Leeds, UK.
3 Health Economics Unit, University of Birmingham, Birmingham, UK.
4 Centre for Immunology & Infectious Disease, Blizard Institute, Barts & The London School of Medicine & Dentistry, London, UK.
5 Barts Health NHS Trust, London, UK.
6 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, 4615 Imperial College London , London, UK.
7 NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
8 Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
9 Department of Ecology and Evolutionary Biology, 6740 Princeton University , Princeton, NJ, USA.


The objective was to determine whether or not the limited use of urethral microscopy to diagnose asymptomatic and symptomatic non-chlamydial, non-gonococcal urethritis (NCNGU) in men is a cost-effective strategy to avert pelvic inflammatory disease (PID), ectopic pregnancy or infertility in female partners. Outputs from a transmission dynamic model of NCNGU in a population of 16-30 year olds in England simulating the number of consultations, PID cases and patients treated over time amongst others, were used along with secondary data to undertake a cost-effectiveness analysis carried out from a health care provider perspective. The main outcome measure was cost per case of PID averted. A secondary outcome measure was cost per major outcome averted, where a major outcome is a case of symptomatic PID, ectopic pregnancy, or infertility. Offering a limited number of asymptomatic men urethral microscopy was more effective than the current practice of no microscopy in terms of reducing the number of cases of PID with an incremental cost-effectiveness ratio of £15,700, meaning that an investment of £15,800 is required to avert one case of PID. For major outcomes averted, offering some asymptomatic men urethral microscopy was again found to be more effective than no microscopy, but here an investment of £49,900 is required to avert one major outcome. Testing asymptomatic men for NCNGU in a small number of genitourinary medicine settings in England is not cost-effective, and thus by maintaining the current practice of not offering this patient group microscopy, this continues to make savings for the health care provider.


Men; non-gonococcal urethritis; urethritis

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