To the Editor:
We read with interest the recent report by Haddix and colleagues,1 who described substantial savings in health care costs when single-dose azithromycin was used for the treatment of cervical Chlamydia trachomatis infection in women. Unfortunately, these savings disappeared when assessment was made of publicly funded clinics, largely because the public sector pays only a fraction of the costs associated with chronic long-term complications.
In the United Kingdom, we have examined the cost effectiveness of a single 1 g dose of azithromycin in the treatment of men with new-episode, microscopically confirmed, nongonococcal urethritis (NGU), in whom Chlamydia trachomatis infection was suspected. The men all attended a National Health Service-funded genitourinary medicine clinic in central London.
One hundred men underwent therapy with a single oral dose of azithromycin (1 g), and 100 were treated with conventional duration therapy with either tetracycline or erythromycin. Patient-led contact tracing was arranged, and patients were asked to return for review when a test of cure was performed. For each patient, the number of clinic visits and any additional treatment were recorded. Men treated with azithromycin required 21 extra clinic attendances compared to 24 extra attendances required by men treated conventionally. There were eight additional visits among the latter group because of medication intolerance, noncompliance, or lost medication, whereas in general azithromycin was well tolerated in the first group.
Azithromycin retails at a discounted cost of £7.37 ($1.00 ≈ £1.50) to our National Health Service trust. Comparable conventional therapy costs are shown in Table 1. The drug costs for the first course of therapy were £737 for the azithromycin-treated cohort and £73.88 for the standard duration group. The exclusive use of oxytetracycline would have reduced costs still further. Additional antibiotic therapy costs amounted to £46.32 for the men treated with azithromycin compared to £79.08 for the group treated conventionally. However, the costs of additional clinic visits for the men receiving conventional therapy must be considered. More than 11 additional visits were made by this group compared to the men treated with azithromycin. The estimated cost of one attendance at our genitourinary medicine clinic was approximately £90, exclusive of drug costs. Hence, the additional clinic attendance costs of men treated conventionally exceeded the costs of those treated with azithromycin by £990. Thus, £359.64 was saved within the public sector when azithromycin was used in the treatment of NGU. Clearly, azithromycin is cost effective in the treatment of men with NGU; in addition, we identified comparable efficacy, improved index follow-up rates, and marked increases in the attendance of traceable sexual contacts in the group treated with azithromycin. than in the group treated conventionally.2 In both treatment groups, more than 70% of participants expressed a preference for single-agent therapy. Health care providers should consider azithromycin as a clinically beneficial and cost-effective first-line agent for the treatment of new-episode NGU in men.
1. Haddix AC, Hillis SD, Kassler WJ. The cost effectiveness of azithromycin for Chlamydia trachomatis
infections in women. Sex Transm Dis 1995; 22: 274–280.
2. Carlin EM, Barton SE. Azithromycin as the first line treatment of non gonococcal urethritis (NGU): A study of follow-up rates, contact attendance and patients' treatment preference. Int J STD AIDS. In press.