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Figure 1. Lowest cost per patient successfully treated on varying
prevalence of gonorrhea and prevalence of ciprofloxacin-resistant Neisseria
gonorrhoeae. Notes: strategy depicted is optimal (lowest cost per
patient successfully treated) for given combinations of prevalence of
gonorrhea and prevalence of ciprofloxacin-resistant N. gonorrhoeae.
Since the alternative strategies are similar in effectiveness, cost-effectiveness
analysis does not offer a practical decision-making tool. Instead, cost
minimization, which selects as optimal a strategy that costs least while
achieving the same level of effectiveness (i.e., per case of successful
treatment), serves as a more practical and intuitive tool kit for decision
making. Case-patients refer to all women who attend a public health clinic
and undergo therapy as per 1 of the 4 strategies, regardless of actual
infection. The strategies modeled were ST1: ciprofloxacin + culture-based
tests + ciprofloxacin-susceptibility tests; ST2: ciprofloxacin + nonculture-based
tests; ST3: ceftriaxone + culture-based tests + ceftriaxone-susceptibility
tests; ST4: ceftriaxone + nonculture-based tests (see Table
1 and text for further details). Values for input variables other
than prevalence of gonorrhea and prevalence of ciprofloxacin-resistant
N. gonorrhoeae are the base case values given in Tables
2 and 3.
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