Modeling gonorrhea vaccination to find optimal targeting strategies that balance impact with cost-effectiveness
File(s)
Published version
Author(s)
Leng, Trystan
Whittles, Lilith K
Nikitin, Dariya
White, Peter J
Type
Journal Article
Abstract
Vaccination for UK men-who-have-sex-with-men (MSM) at increased gonorrhea risk has been advised, but not yet implemented. Effective targeting is essential for cost-effectiveness, but previously-examined approaches
have disadvantages: Vaccination-on-Diagnosis has low coverage (limiting impact), and Vaccination-according-
to-Risk requires asking about sexual behavior to identify at-risk individuals, which is not always feasible. We
developed a transmission-dynamic model to evaluate novel strategies offering vaccination based on information readily-available to clinicians (diagnostic/vaccination history, if the patient is seeking care due to partner notification). Offering vaccination to MSM who are notified partners of gonorrhea cases or were diagnosed themselves in the past 2 years averts 1.6x more cases and is more cost-effective than Vaccination-on-Diagnosis. If vaccination provides 20% protection for 1.5 years after primary vaccination and 3 years after revaccination then at £18/dose administered, all considered strategies have ≥ 50% and ≥ 90% probabilities of positive net monetary benefit compared with no vaccination with a quality-adjusted life year valued at £20,000 and £30,000 respectively, thus meeting the UK criteria for cost-effectiveness. All novel strategies considered achieve greater impact than Vaccination-on-Diagnosis without the feasibility issues of Vaccination-according-to-Risk.
have disadvantages: Vaccination-on-Diagnosis has low coverage (limiting impact), and Vaccination-according-
to-Risk requires asking about sexual behavior to identify at-risk individuals, which is not always feasible. We
developed a transmission-dynamic model to evaluate novel strategies offering vaccination based on information readily-available to clinicians (diagnostic/vaccination history, if the patient is seeking care due to partner notification). Offering vaccination to MSM who are notified partners of gonorrhea cases or were diagnosed themselves in the past 2 years averts 1.6x more cases and is more cost-effective than Vaccination-on-Diagnosis. If vaccination provides 20% protection for 1.5 years after primary vaccination and 3 years after revaccination then at £18/dose administered, all considered strategies have ≥ 50% and ≥ 90% probabilities of positive net monetary benefit compared with no vaccination with a quality-adjusted life year valued at £20,000 and £30,000 respectively, thus meeting the UK criteria for cost-effectiveness. All novel strategies considered achieve greater impact than Vaccination-on-Diagnosis without the feasibility issues of Vaccination-according-to-Risk.
Date Issued
2025-06-21
Date Acceptance
2025-05-08
Citation
npj Vaccines, 2025, 10
ISSN
2059-0105
Publisher
Nature Portfolio
Journal / Book Title
npj Vaccines
Volume
10
Copyright Statement
© The Author(s) 2025 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1038/s41541-025-01159-0
Publication Status
Published
Article Number
128
Date Publish Online
2025-06-21