Choo Jun Hao, Lopez-Varela Elisa, Fuente-Soro Laura, Augusto Orvalho, Sacoor Charfudin, Nhacolo Ariel, Wei Stanley, Naniche Denise, Thomas Ranjeeta, Sicuri Elisa
Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
Cost Eff Resour Alloc. 2022 Sep 6;20(1):49. doi: 10.1186/s12962-022-00378-9.
Despite the high HIV associated burden, Mozambique lacks data on HIV counselling and testing (HCT) costs. To help guide national HIV/AIDS programs, we estimated the cost per test for voluntary counselling and testing (VCT) from the patient's perspective and the costs per person tested and per HIV-positive individual linked to care to the healthcare provider for VCT, provider-initiated counselling and testing (PICT) and home-based testing (HBT). We also assessed the cost-effectiveness of these strategies for linking patients to care.
Data from a cohort study conducted in the Manhiça District were used to derive costs and linkage-to-care outcomes of the three HCT strategies. A decision tree was used to model HCT costs according to the likelihood of HCT linking individuals to care and to obtain the incremental cost-effectiveness ratios (ICERs) of PICT and HBT with VCT as the comparator. Sensitivity analyses were performed to assess robustness of base-case findings.
Based on costs and valuations in 2015, average and median VCT costs to the patient per individual tested were US$1.34 and US$1.08, respectively. Costs per individual tested were greatest for HBT (US$11.07), followed by VCT (US$7.79), and PICT (US$7.14). The costs per HIV-positive individual linked to care followed a similar trend. PICT was not cost-effective in comparison with VCT at a willingness-to-accept threshold of US$4.53, but only marginally given a corresponding base-case ICER of US$4.15, while HBT was dominated, with higher costs and lower impact than VCT. Base-case results for the comparison between PICT and VCT presented great uncertainty, whereas findings for HBT were robust.
PICT and VCT are likely equally cost-effective in Manhiça. We recommend that VCT be offered as the predominant HCT strategy in Mozambique, but expansion of PICT could be considered in limited-resource areas. HBT without facilitated linkage or reduced costs is unlikely to be cost-effective.
尽管与艾滋病病毒相关的负担沉重，但莫桑比克缺乏关于艾滋病病毒咨询和检测（HCT）成本的数据。为帮助指导国家艾滋病病毒/艾滋病项目，我们从患者角度估算了自愿咨询和检测（VCT）的每次检测成本，以及医疗服务提供者为VCT、提供者发起的咨询和检测（PICT）及居家检测（HBT）的每人检测成本和每名与护理建立联系的艾滋病毒阳性个体的成本。我们还评估了这些将患者与护理建立联系的策略的成本效益。
利用在曼希卡区进行的一项队列研究的数据，得出三种HCT策略的成本及与护理建立联系的结果。使用决策树根据HCT将个体与护理建立联系的可能性对HCT成本进行建模，并以VCT作为对照，得出PICT和HBT的增量成本效益比（ICER）。进行敏感性分析以评估基础案例结果的稳健性。
根据2015年的成本和估值，患者接受VCT检测的平均成本和中位数成本分别为1.34美元和1.08美元。HBT的每人检测成本最高（11.07美元），其次是VCT（7.79美元）和PICT（7.14美元）。每名与护理建立联系的艾滋病毒阳性个体的成本也呈现类似趋势。在4.53美元的可接受阈值下，与VCT相比，PICT不具有成本效益，但考虑到相应的基础案例ICER为4.15美元，只是勉强如此，而HBT则处于劣势，成本高于VCT且影响低于VCT。PICT与VCT比较的基础案例结果存在很大不确定性，而HBT的结果则较为稳健。
在曼希卡，PICT和VCT可能同样具有成本效益。我们建议在莫桑比克将VCT作为主要的HCT策略，但在资源有限的地区可考虑扩大PICT。没有便利联系或成本降低的HBT不太可能具有成本效益。
