BC Centre for Excellence in HIV/AIDS, Vancouver.
Faculty of Health Sciences, Simon Fraser University, Burnaby.
Clin Infect Dis. 2018 Feb 10;66(5):765-777. doi: 10.1093/cid/cix832.
Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013.
Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective.
ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV.
HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
认识到抗逆转录病毒疗法（ART）的二级预防益处，促使全球努力“发现、检测、治疗和留住”艾滋病毒感染者[HIV/AIDS（PLHIV）]，使他们参与艾滋病毒护理。我们旨在确定 2011-2013 年在加拿大不列颠哥伦比亚省启动的一系列艾滋病毒检测和治疗参与干预措施的成本效益。
使用先前验证的动态 HIV 传播模型，链接 PLHIV 的个人健康行政数据和汇总水平的 HIV 检测数据，我们估计了初级保健检测（医院、急诊室[ED]、门诊）、ART 启动和 ART 保留干预措施相对于近似现状的假设情景的成本效益。估计了 HIV 发病率、死亡率、成本（2015 年加元）、质量调整生命年（QALY）和增量成本效益比。从政府支付者的角度，在 5 至 25 年的时间范围内进行了分析。
ED 检测的每获得一个 QALY 的成本效益最高，为 30216 加元，对 PLHIV 的发病率和死亡率影响最大，而 ART 启动则提供了最大的 QALY 获益。ART 保留干预措施没有成本效益。按照观察到的规模实施并在整个研究期间持续进行，我们估计，在每获得一个 QALY 的成本为 55258 加元的情况下，PLHIV 的累积 HIV 发病率将降低 12.8%，死亡人数将减少 4.7%。结果对未确诊的 PLHIV 数量的不确定性最为敏感。
HIV 检测和 ART 启动干预措施具有成本效益，而 ART 保留干预措施则没有。制定重新吸引失去护理的 PLHIV 的策略是今后的优先事项。
