Varghese B, Peterman T A, Holtgrave D R
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
AIDS. 1999 Sep 10;13(13):1745-51. doi: 10.1097/00002030-199909100-00019.
Counseling and testing and partner notification are effective HIV prevention strategies, but they can be resource intensive. This paper evaluates the cost-effectiveness of partner notification and counseling and testing offered in HIV and sexually transmitted disease (STD) clinics in preventing future HIV infections in the United States of America.
Decision trees were developed from both societal and provider perspectives. The counseling and testing and partner notification models incorporate estimates of HIV prevalence, return rates for counseling, risk of HIV transmission within 1 year, and the effectiveness of counseling. Cost estimates for counseling and testing and partner notification programs and lifetime treatment cost of HIV for the United States of America were obtained from published literature. Extensive sensitivity analyses of model parameters were conducted.
For a cohort of 10,000 individuals at a clinic with an HIV seroprevalence of 1.5%, we estimate that counseling and testing prevents eight HIV infections and saves society almost $1,000,000. We estimate that partner notification for the 113 infected persons identified by counseling and testing, prevents another 1.2 HIV infections and saves an additional $181,000. To the provider (HIV and STD clinics), this translates to a cost of $32,000 per case prevented by counseling and testing and an additional $28,000 for partner notification. Model results are most sensitive to assumptions of HIV prevalence, risk of transmission, and treatment cost of HIV.
Counseling and testing and partner notification are cost effective in preventing HIV transmission in this setting. This model can be adapted to assess the cost-effectiveness of counseling and testing and partner notification in other settings.
咨询与检测以及性伴通知是有效的艾滋病预防策略，但可能耗费大量资源。本文评估了在美国艾滋病和性传播疾病（STD）诊所提供的性伴通知以及咨询与检测在预防未来艾滋病感染方面的成本效益。
从社会和医疗机构的角度构建决策树。咨询与检测以及性伴通知模型纳入了艾滋病流行率估计、咨询回访率、1年内艾滋病传播风险以及咨询效果。咨询与检测及性伴通知项目的成本估计以及美国艾滋病终身治疗成本均来自已发表的文献。对模型参数进行了广泛的敏感性分析。
对于一家艾滋病血清流行率为1.5%的诊所中的10000人队列，我们估计咨询与检测可预防8例艾滋病感染，为社会节省近100万美元。我们估计，对咨询与检测发现的113名感染者进行性伴通知，可再预防1.2例艾滋病感染，并额外节省18.1万美元。对于医疗机构（艾滋病和性传播疾病诊所）而言，这意味着通过咨询与检测预防一例的成本为3.2万美元，性伴通知额外成本为2.8万美元。模型结果对艾滋病流行率、传播风险和艾滋病治疗成本的假设最为敏感。
在这种情况下，咨询与检测以及性伴通知在预防艾滋病传播方面具有成本效益。该模型可进行调整，以评估在其他情况下咨询与检测以及性伴通知的成本效益。
