Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo; Bansi-Matharu, Loveleen; Wilson, David; Jani, Ilesh; Apollo, Tsitsi; Sculpher, Mark; Hallett, Timothy; Kerr, Cliff; van Oosterhout, Joep J; Eaton, Jeffrey W; Estill, Janne; Williams, Brian; Doi, Naoko; Cowan, Frances; Keiser, Olivia; Ford, Deborah; Hatzold, Karin; Barnabas, Ruanne; ... (2019). Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis. Journal of the International AIDS Society, 22(7), e25325. BioMed Central 10.1002/jia2.25325
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INTRODUCTION
As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost-effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric.
METHODS
We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of "core" testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core-testing as above plus additional testing beyond this ("additional-testing"), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars).
RESULTS
There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost-effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost-effective up to a cost-per-diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost-effective fell to $256 when the cost-effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum.
CONCLUSIONS
For testing programmes in low-income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost-per-DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost-effectiveness of testing programmes.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
08 Faculty of Science > Department of Mathematics and Statistics > Institute of Mathematical Statistics and Actuarial Science |
UniBE Contributor: |
Estill, Janne Anton Markus |
Subjects: |
300 Social sciences, sociology & anthropology > 360 Social problems & social services 500 Science > 510 Mathematics |
ISSN: |
1758-2652 |
Publisher: |
BioMed Central |
Language: |
English |
Submitter: |
Andrea Flükiger-Flückiger |
Date Deposited: |
31 Jul 2019 15:43 |
Last Modified: |
05 Dec 2022 15:29 |
Publisher DOI: |
10.1002/jia2.25325 |
PubMed ID: |
31287620 |
Uncontrolled Keywords: |
HIV cost-effectiveness health systems modelling testing |
BORIS DOI: |
10.7892/boris.132014 |
URI: |
https://boris.unibe.ch/id/eprint/132014 |