Dataset Information

Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial.

ABSTRACT:

Background

The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results.

Objective

To examine the costs and benefits of strategies to improve HIV testing and receipt of results.

Design

Cost-effectiveness analysis based on a Markov model. Acceptance of testing, return rates, and related costs were derived from a randomized trial of 251 patients; long-term costs and health outcomes were derived from the literature. SETTING/TARGET POPULATION: Primary-care patients with unknown HIV status.

Interventions

Comparison of three intervention models for HIV counseling and testing: Model A = traditional HIV counseling and testing; Model B = nurse-initiated routine screening with traditional HIV testing and counseling; Model C = nurse-initiated routine screening with rapid HIV testing and streamlined counseling.

Main measures

Life-years, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness.

Key results

Without consideration of the benefit from reduced HIV transmission, Model A resulted in per-patient lifetime discounted costs of $48,650 and benefits of 16.271 QALYs. Model B increased lifetime costs by $53 and benefits by 0.0013 QALYs (corresponding to 0.48 quality-adjusted life days). Model C cost $66 more than Model A with an increase of 0.0018 QALYs (0.66 quality-adjusted life days) and an incremental cost-effectiveness of $36,390/QALY. When we included the benefit from reduced HIV transmission, Model C cost $10,660/QALY relative to Model A. The cost-effectiveness of Model C was robust in sensitivity analyses.

Conclusions

In a primary-care population, nurse-initiated routine screening with rapid HIV testing and streamlined counseling increased rates of testing and receipt of test results and was cost-effective compared with traditional HIV testing strategies.

SUBMITTER: Sanders GD

PROVIDER: S-EPMC2869414 | biostudies-literature | 2010 Jun

REPOSITORIES: biostudies-literature

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Publications

Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial.

Sanders Gillian D GD Anaya Henry D HD Asch Steven S Hoang Tuyen T Golden Joya F JF Bayoumi Ahmed M AM Owens Douglas K DK

Journal of general internal medicine 20100304 6

<h4>Background</h4>The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results.<h4>Objective</h4>To examine the costs and benefits of strategies to improve HIV testing and receipt of results.<h4>Design</h4>Cost-effectiveness analysis based on a Markov model. Acceptance of testing, return rates, and related costs were deriv ...[more]

PMID: 20204538

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Project description:INTRODUCTION:The prevalence of undiagnosed HIV is declining in Africa, and various HIV testing approaches are finding lower positivity rates. In this context, the epidemiological impact and cost-effectiveness of community-based HIV self-testing (CB-HIVST) is unclear. We aimed to assess this in different sub-populations and across scenarios characterized by different adult HIV prevalence and antiretroviral treatment programmes in sub-Saharan Africa. METHODS:The synthesis model was used to address this aim. Three sub-populations were considered for CB-HIVST: (i) women having transactional sex (WTS); (ii) young people (15 to 24 years); and (iii) adult men (25 to 49 years). We assumed uptake of CB-HIVST similar to that reported in epidemiological studies (base case), or assumed people use CB-HIVST only if exposed to risk (condomless sex) since last HIV test. We also considered a five-year time-limited CB-HIVST programme. Cost-effectiveness was defined by an incremental cost-effectiveness ratio (ICER; cost-per-disability-adjusted life-year (DALY) averted) below US$500 over a time horizon of 50 years. The efficiency of targeted CB-HIVST was evaluated using the number of additional tests per infection or death averted. RESULTS:In the base case, targeting adult men with CB-HIVST offered the greatest impact, averting 1500 HIV infections and 520 deaths per year in the context of a simulated country with nine million adults, and impact could be enhanced by linkage to voluntary medical male circumcision (VMMC). However, the approach was only cost-effective if the programme was limited to five years or the undiagnosed prevalence was above 3%. CB-HIVST to WTS was the most cost-effective. The main drivers of cost-effectiveness were the cost of CB-HIVST and the prevalence of undiagnosed HIV. All other CB-HIVST scenarios had an ICER above US$500 per DALY averted. CONCLUSIONS:CB-HIVST showed an important epidemiological impact. To maximize population health within a fixed budget, CB-HIVST needs to be targeted on the basis of the prevalence of undiagnosed HIV, sub-population and the overall costs of delivering this testing modality. Linkage to VMMC enhances its cost-effectiveness.

Dataset Information

Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial.

Background

Objective

Design

Interventions

Main measures

Key results

Conclusions

Publications

Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial.

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