(P360) Estimating quality-adjusted life years (QALYs) lost due to five sexually transmitted diseases in the United States

Background

Estimates of the quality-of-life impacts of STDs are needed to quantify the health burden of STDs and to inform cost-effectiveness analyses of STD prevention interventions.



Methods

We developed estimates of quality adjusted life years (QALYs) lost per infection for five STDs: genital herpes (HSV-1 and HSV-2), syphilis, chlamydia, gonorrhea, trichomoniasis, including the associated neonatal infections due to herpes, and syphilis. The estimates of discounted lifetime QALYs lost accounted for short-term and long-term sequelae directly attributed to the infections. Selected estimates were age-stratified depending on data availability; all estimates were stratified by sex (women, men) and syphilis outcomes were stratified by men who have sex with women (MSW) and men who have sex with men (MSM). We report i) QALYs lost per incident infection (mean and 95% uncertainty interval [95%UI]) based on multivariate sensitivity analysis reflecting uncertainty around natural history and disutility estimates; and ii) the total number of lifetime QALYs lost due to incident infections in 2018 (multiplying per-infection QALYs lost by published estimates of STD incidence in 2018 in the United States).



Results

QALYs lost per incident infection are presented in figure 1. The largest QALY losses were 7.93 (95%UI 6.63-9.19) per case of neonatal herpes and 1.85 (95%UI 1.44-2.30) per case of congenital syphilis. The smallest QALY losses were associated with chlamydia, gonorrhea and trichomoniasis in men: ranging from 0.00012 (trichomoniasis) to 0.0014 (gonorrhea); respective QALYs lost for women were 10-50 times higher (e.g. 0.047 [95%UI 0.013-0.113] for chlamydia) given more serious sequelae in women on average. For genital herpes and syphilis, estimates did not differ as markedly by sex. In total, an estimated 178,000 lifetime QALYs lost were due to incident infections of genital herpes, syphilis, chlamydia, gonorrhea, and trichomoniasis in 2018, and 5,550 QALYs lost were due to neonatal herpes and congenital syphilis.



Conclusions

Evidence gaps identified at multiple levels (natural history, long-term sequelae, and disutility estimates) highlight the need for further research on the epidemiology of STDs. Our evidence synthesis of adverse health outcomes associated with different STDs contributes to quantifying the total burden of STDs in a high-income country setting.