Long Elisa F, Mandalia Roshni, Mandalia Sundhiya, Alistar Sabina S, Beck Eduard J, Brandeau Margaret L
UCLA Anderson School of Management, Los Angeles, California, United States of America.
Co-ordinating and Analytic Centre, National Prospective Monitoring System - HIV Health-economics Collaboration (NPMS-HHC CIC), London, United Kingdom.
PLoS One. 2014 Apr 24;9(4):e95735. doi: 10.1371/journal.pone.0095735. eCollection 2014.
In many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed.
We developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries.
We estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness.
Annual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000-£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4-15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained.
Annual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries.
在许多艾滋病毒流行率较低的高收入国家，仍有大量艾滋病毒感染者（PLHIV）未被诊断出来。通过艾滋病毒检测识别PLHIV能使他们及时获得挽救生命的抗逆转录病毒疗法（ART），并减少艾滋病毒传播。我们估计了在英国进行艾滋病毒检测的有效性和成本效益，据估计英国有25%的PLHIV未被诊断出来。
我们开发了一个动态分区模型，以分析在英国扩大艾滋病毒检测和治疗的策略，特别关注男男性行为者（MSM）、注射吸毒者（PWID）以及来自艾滋病毒流行国家的个人。
我们估计了10年内的艾滋病毒流行率、发病率、质量调整生命年（QALYs）和医疗保健成本以及成本效益。
对所有成年人进行年度艾滋病毒检测可以避免5%的新感染，即使在艾滋病毒诊断后没有行为改变（因为更早开始接受ART治疗），如果危险行为减半则可避免高达18%的新感染。该策略每获得一个QALY的成本为67,000 - 106,000英镑。仅对MSM、PWID和来自艾滋病毒流行国家的人进行年度检测，并对所有其他成年人进行一次性检测，可预防4 - 15%的感染，诊断每个PLHIV所需的检测数量减少四分之三，每获得一个QALY的成本为17,500英镑。通过增加ART可及性来扩大该计划，在10年内可为人群增加145,000个QALY，每获得一个QALY的成本为26,800英镑。
在英国对重点人群进行年度艾滋病毒检测具有很高的成本效益。对所有其他成年人进行额外的一次性检测可以识别出大多数未被诊断的PLHIV。这些发现可能与其他低流行率的高收入国家相关。
