Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
Appl Health Econ Health Policy. 2023 Jul;21(4):585-601. doi: 10.1007/s40258-022-00782-5. Epub 2023 Feb 28.
Economic evaluations, a decision-support tool for policy makers, will be crucial in planning and tailoring HIV prevention and treatment strategies especially in the wake of stalled and decreasing funding for the global HIV response. As HIV testing and treatment coverage increase, case identification becomes increasingly difficult and costly. Determining which subset of the population these strategies should be targeted to becomes of vital importance as well. Generating quality economic evidence begins with the validity of the modelling approach and the model structure employed. This study synthesises and critiques the reporting around modelling methodology of economic models in the evaluation of HIV testing strategies in sub-Saharan Africa.
The following databases were searched from January 2000 to September 2020: MEDLINE, Embase, Scopus, EconLit and Global Health. Any model-based economic evaluation of a unique HIV testing strategy conducted in sub-Saharan Africa presenting a cost-effectiveness measure published from 2013 onwards was eligible. Data were extracted around three components: general study characteristics; economic evaluation design; and quality of model reporting using a novel tool developed for the purposes of this study.
A total of 21 studies were included; 10 cost-effectiveness analyses, 11 cost-utility analyses. All but one study was conducted in Eastern and Southern Africa. Modelling approaches for HIV testing strategies can be broadly characterised as static aggregate models (3/21), static individual models (6/21), dynamic aggregate models (5/21) and dynamic individual models (7/21). Adequate reporting around data handling was the highest of the three categories assessed (74%), and model validation, the lowest (45%). Limitations to model structure, justification of chosen time horizon and cycle length, and description of external model validation process were all adequately reported in less than 40% of studies. The predominant limitation of this review relates to the potential implications of the narrow inclusion criteria.
This review is the first to synthesise economic evaluations of HIV testing strategies in sub-Saharan Africa. The majority of models exhibited dynamic, stochastic and individual properties. Model reporting against the 13 criteria in our novel tool was mixed. Future model-based economic evaluations of HIV testing strategies would benefit from transparency around the choice of modelling approach, model structure, data handling procedures and model validation techniques.
经济评估是决策者的决策支持工具，在规划和调整艾滋病毒预防和治疗策略方面将至关重要，尤其是在全球艾滋病毒应对资金停滞和减少的情况下。随着艾滋病毒检测和治疗覆盖率的提高，病例识别变得越来越困难和昂贵。确定这些策略应针对的人群子集也变得至关重要。生成高质量的经济证据始于建模方法的有效性和所采用的模型结构。本研究综合并批评了撒哈拉以南非洲艾滋病毒检测策略评估中经济模型建模方法的报告。
从 2000 年 1 月至 2020 年 9 月，在以下数据库中进行了搜索：MEDLINE、Embase、Scopus、EconLit 和全球卫生。符合条件的研究为：在撒哈拉以南非洲进行的、具有独特艾滋病毒检测策略的、基于模型的经济评估，报告了 2013 年以来发表的成本效益衡量标准。提取了三个方面的数据：一般研究特征；经济评估设计；以及使用为此目的开发的新工具报告模型质量。
共纳入 21 项研究；10 项成本效益分析，11 项成本效用分析。除一项研究外，所有研究均在东非和南非进行。艾滋病毒检测策略的建模方法可大致分为静态综合模型（3/21）、静态个体模型（6/21）、动态综合模型（5/21）和动态个体模型（7/21）。在评估的三个类别中，数据处理报告最高（74%），模型验证最低（45%）。模型结构的局限性、所选时间范围和周期长度的合理性、以及外部模型验证过程的描述，在不到 40%的研究中得到了充分报告。本综述的主要局限性在于纳入标准狭窄可能带来的影响。
这是第一份综合撒哈拉以南非洲艾滋病毒检测策略经济评估的综述。大多数模型表现出动态、随机和个体特性。根据我们新工具中的 13 项标准对模型进行报告的情况参差不齐。未来基于模型的艾滋病毒检测策略经济评估将受益于建模方法选择、模型结构、数据处理程序和模型验证技术的透明度。
