Dataset Information

Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes.

ABSTRACT:

Background

A study of a comprehensive HIV Care Coordination Program (CCP) showed effectiveness in increasing viral load suppression (VLS) among PLWH in New York City (NYC). We evaluated the cost-effectiveness of a scale-up of the CCP in NYC.

Methods

We incorporated observed effects and costs of the CCP into a computer simulation of HIV in NYC, comparing strategy scale-up with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, and was calibrated to NYC HIV epidemiological data from 1997 to 2009. We assessed incremental cost-effectiveness from a health sector perspective using 2017 $US, a 20-year time horizon, and a 3% annual discount rate. We explored two scenarios: (1) two-year average enrollment and (2) continuous enrollment.

Results

In scenario 1, scale-up resulted in a cost-per-infection-averted of $898,104 and a cost-per-QALY-gained of $423,721. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.37 or costs decreased by 41.7%. Limiting the intervention to persons with unsuppressed viral load prior to enrollment (RR1.32) attenuated the cost reduction necessary to 11.5%. In scenario 2, scale-up resulted in a cost-per-infection-averted of $705,171 and cost-per-QALY-gained of $720,970. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.46 or program costs decreased by 71.3%. Limiting the intervention to persons with unsuppressed viral load attenuated the cost reduction necessary to 38.7%.

Conclusion

Cost-effective CCP scale-up would require reduced costs and/or focused enrollment within NYC, but may be more readily achieved in cities with lower background VLS levels.

SUBMITTER: Stevens ER

PROVIDER: S-EPMC6483203 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes.

Stevens Elizabeth R ER Nucifora Kimberly A KA Irvine Mary K MK Penrose Katherine K Robertson McKaylee M Kulkarni Sarah S Robbins Rebekkah R Abraham Bisrat B Nash Denis D Braithwaite R Scott RS

PloS one 20190425 4

<h4>Background</h4>A study of a comprehensive HIV Care Coordination Program (CCP) showed effectiveness in increasing viral load suppression (VLS) among PLWH in New York City (NYC). We evaluated the cost-effectiveness of a scale-up of the CCP in NYC.<h4>Methods</h4>We incorporated observed effects and costs of the CCP into a computer simulation of HIV in NYC, comparing strategy scale-up with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a ...[more]

PMID: 31022280

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Dataset Information

Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes.

Background

Methods

Results

Conclusion

Publications

Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes.

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