Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA.
Health Services and Outcomes Research, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.
Lancet Glob Health. 2023 Aug;11(8):e1217-e1224. doi: 10.1016/S2214-109X(23)00216-4.
The HITSystem efficacy trial showed significant improvements in early infant diagnosis retention, return and notification of infant test results, and earlier antiretroviral therapy (ART) initiation compared with standard-of-care early infant diagnosis services in Kenya. This study aimed to analyse data from the HITSystem trial to assess the cost-effectiveness of the intervention in Kenya.
In this analysis, we extrapolated results from the HITSystem cluster randomised controlled trial to model early infant diagnosis outcomes and cost-effectiveness if the HITSystem was scaled up nationally in Kenya, compared with standard-of-care outcomes. We used a micro-costing method to collect cost data, which were analysed from a health-system perspective, reflecting the investment required to add HITSystem to existing early infant diagnosis services and infrastructure. The base model used to calculate cost-effectiveness was deterministic and calculated the progression of infants through early infant diagnosis. Differences in progression across study arms were used to establish efficacy outcomes. The number of life-years gained per infant successfully initiating ART were based on the Cost Effectiveness of Preventing AIDS Complications model in east Africa. HITSystem cost data were integrated into the model, and the incremental cost-effectiveness ratio was calculated in terms of cost per life-year gained. Sensitivity analyses were done using the deterministic model with triangular stochastic probability functions for key model parameters added. The number of life-years gained was discounted at 3% and costs were adjusted to 2021 values.
The cost per life-year gained from the HITSystem was US$82·72. Total cost for national HITSystem coverage in Kenya was estimated to be around $2·6 million; covering 82 230 infants exposed to HIV at a cost of $31·38 per infant and a yield of 1133 infants receiving timely ART, which would result in 31 189 life-years gained. With sensitivity analyses, the cost per life-year gained varied from $40·13 to $215·05. 90% of model values across iterations ranged between $55·58 (lower 5% threshold) and $132·38 (upper 95% threshold).
The HITSystem would be very cost-effective in Kenya and can optimise the return on the existing investment in the national early infant diagnosis programme.
The US National Institute of Child Health and Human Development.
HITSystem 疗效试验表明，与肯尼亚标准的婴幼儿早期诊断服务相比，该系统在婴幼儿早期诊断保留率、复诊率、婴儿检测结果通知率以及更早开始抗逆转录病毒治疗（ART）方面有显著改善。本研究旨在分析 HITSystem 试验数据，以评估该干预措施在肯尼亚的成本效益。
在这项分析中，我们从 HITSystem 群组随机对照试验中推断结果，以评估如果 HITSystem 在肯尼亚全国范围内推广，与标准护理结果相比，婴幼儿早期诊断结果和成本效益。我们使用微观成本法收集成本数据，从卫生系统角度进行分析，反映了在现有婴幼儿早期诊断服务和基础设施中添加 HITSystem 所需的投资。用于计算成本效益的基本模型是确定性的，用于计算婴儿通过婴幼儿早期诊断的进展情况。研究臂之间的进展差异用于确定疗效结果。每个成功开始接受 ART 治疗的婴儿所获得的生命年数是基于东非预防艾滋病并发症成本效益模型计算的。HITSystem 成本数据被整合到模型中，并计算了每获得一个生命年所需的增量成本效益比。使用三角随机概率函数对关键模型参数进行了确定性模型的敏感性分析。获得的生命年数以 3%的折扣率贴现，成本以 2021 年的价值进行调整。
HITSystem 每获得一个生命年的成本为 82.72 美元。肯尼亚全国范围内 HITSystem 覆盖的总成本估计约为 260 万美元；覆盖 82230 名感染 HIV 的婴儿，每个婴儿的成本为 31.38 美元，预计将有 1133 名婴儿及时接受 ART 治疗，从而获得 31189 个生命年。通过敏感性分析，每个生命年的成本从 40.13 美元到 215.05 美元不等。迭代过程中 90%的模型值在 55.58 美元（较低的 5%阈值）和 132.38 美元（较高的 95%阈值）之间。
HITSystem 在肯尼亚非常具有成本效益，可以优化国家婴幼儿早期诊断计划现有投资的回报。
美国国立儿童健康与人类发展研究所。
