Instituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador.
Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador.
Front Public Health. 2022 Jun 17;10:884313. doi: 10.3389/fpubh.2022.884313. eCollection 2022.
HIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy "95-95-95" which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost-utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts.
For the cost-utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths.
Cost-benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (-$591, -$4,360) and -108 and -934 DALYs, in the case of ART and PrEP, ICER the $30,541-$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10-12 years of healthy life.
CUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life.
艾滋病病毒（HIV）被认为是全球最重要的慢性传染病之一。联合国艾滋病规划署（UNAIDS）在 2020 年提出了“95-95-95”战略，目标是实现 95%的病例得到发现、接受抗逆转录病毒治疗（ART）并实现病毒抑制。在厄瓜多尔，根据公共卫生部的数据，截至 2020 年，有 45056 人感染了 HIV，主要是 15 至 49 岁的男性，死亡率为每 10 万人中有 4.8 人。本研究旨在确定对有性行为人群进行早期筛查与仅对高危人群进行筛查的成本效益，并确定在不同情况下使用暴露前预防（PrEP）是否合理。
为了进行成本效益评估，我们比较了以下两种情况：（a）仅对高危人群进行 HIV 筛查与对所有有性行为的人群进行 HIV 筛查；（b）仅将 ART 用于 HIV 治疗与将 ART 用于诊断病例的治疗以及在高危人群中使用 PrEP。通过世界卫生组织（WHO）的指南获得了 HIV/AIDS 的 DALY 计算和权重。为了生成 HIV/AIDS 的马尔可夫模型，将研究对象分为有症状和无症状人群，以及 HIV 死亡人群。
成本效益分析（CUA）表明，早期诊断的增量成本效益比（ICER）为负值，这意味着如果将该策略作为常规检测实施，将节省成本（-591 美元，-4360 美元），并且在使用 ART 和 PrEP 的情况下，ICER 值分别为 30541 美元至 59410 美元，这意味着超过了国内生产总值（GDP）的阈值和普通人群中 2.511 至 10.635 年的健康寿命。如果将早期诊断的预算减少 70%，厄瓜多尔人可能会损失 4 至 6 个 DALY，而如果将预算减少超过 50%用于 ART，则会导致 10 至 12 年的健康寿命损失。
CUA 表明，对有性行为的人群进行早期诊断具有成本效益。将其与 ART 或 PrEP 结合使用，可以增加健康寿命。
