Zah Vladimir, Toumi Mondher
Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France; ZRx Outcomes Research Inc., Mississauga, Canada.
Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France.
HIV AIDS (Auckl). 2016 Mar 15;8:67-74. doi: 10.2147/HIV.S96713. eCollection 2016.
To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population.
A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M).
In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years).
The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.
建立一个模型，以评估实施干预措施对增加英国特定人群中早期检测出的艾滋病毒感染比例所产生的预算和生存影响。
设计了一个Microsoft Excel决策模型，以生成特定人群的一组结果。生存情况以欧洲观察性艾滋病毒流行病学研究协作组（COHERE）的研究为模型，外推至5年，采用恒定风险率。风险率因年龄、性别以及检测是早期还是晚期而异。直至5年的每年主要结果为：年度成本、感染病例数、住院人数和存活病例数。选择英国的三个地点来模拟不同艾滋病毒流行地区的结果：兰贝斯、南华克和刘易舍姆（LSL）、大曼彻斯特集群（GMC）以及肯特和梅德韦（K&M）。
在LSL，若将节省的104个生命年的价值计算在内，预计5年累计成本节省为3,210,206英镑或5,290,206英镑。节省对传播率不敏感，但与从晚期检测向早期检测转变的百分比成正比。在GMC，节省比例与LSL相似，但幅度较小，这是由于基础病例艾滋病毒流行率较低。在K&M，由于人口比GMC少且艾滋病毒流行率较低，节省幅度相应较小（5年累计为733,202英镑）。
结果强化了在高流行地区增加检测的合理性。然而，在低流行地区，5年内不太可能收回成本。
