The CEA Registry Blog

Dec 1

by CEA Registry Team 12/1/2011 8:17 PM  RssIcon

December 1st is World AIDs Day.  Despite huge advances in the management of the disease, the AIDS pandemic still claims millions of lives each year.  It was estimated that 2.1 million people died due to AIDS in 2007, approximately 15% of whom were children.[1]  At the end of 2008, approximately 1.8 million persons aged 13 and older were living with HIV infection in the United States. [2]

In this blog post, we highlight research on the cost-effectiveness of HIV related interventions.  A search of the Tufts CEA Registry yields approximately 500 ratios for HIV-related interventions.  For this blog, we have chosen to focus our attention on HIV screening.

Table 1 shows the findings of a search for cost-effectiveness estimates of HIV screening interventions published from 2010 through 2011.*  The studies evaluate various screening approaches, from routine screening of primary care patients, to the retesting of HIV-seronegative people. [3,4]  Despite some belief that screening saves money, all 10 cost-effectiveness ratios were positive, i.e., screening was associated with a positive net cost to society.  However, for the studies considered here, screening was typically highly cost-effective with the highest ratio $43,000 per QALY. [3]  Interestingly, despite being often thought of as a disease of primary relevance to Africa, many of the ratios pertain to US patient populations, reinforcing the fact that AIDS remains a global health concern.

Table 1.  Published estimates of cost-effectiveness for HIV related screening interventions (2009-2011)

Reference

Intervention and comparator

Population

US$/

QALY*

Sanders 2010 J Gen Intern Med

Nurse-initiated routine screening with traditional HIV testing and counseling VS. Traditional HIV counseling and testing

Primary-care patients with unknown HIV status with consideration of the benefit of reduced HIV transmission in the US

14,000

Sanders 2010 J Gen Intern Med

Nurse-initiated routine screening with rapid HIV testing and streamlined counseling VS. Traditional HIV counseling and testing

Primary-care patients with unknown HIV status without consideration of the benefit of reduced HIV transmission in the US

38,000

Sanders 2010 J Gen Intern Med

Nurse-initiated routine screening with traditional HIV testing and counseling VS. Traditional HIV counseling and testing

Primary-care patients with unknown HIV status without consideration of the benefit of reduced HIV transmission  in the US

43,000

Waters 2011 J Acquir Immune Defic Syndr

Retesting HIV at 7.5 yrs for 0.8%/1.3%/4.0% annual HIV incidence VS. No retesting in people with low risk or no change in risk after being tested negative

HIV-seronegative people in sub-Saharan Africa

710/840/ 920

Walensky 2011 J Acquir Immune Defic Syndr

One time HIV screening VS. Current practice

General population of South Africa

1,600

Walensky 2011 J Acquir Immune Defic Syndr

HIV screening every 5 yrs VS. Current practice

General population of South Africa

1,700

Walensky 2011 J Acquir Immune Defic Syndr

Annual HIV screening VS. Screening every 5 yrs

General population of South Africa

1,900

Long 2010 Ann Intern Med

Combination (screening for HIV in low-risk person once and in high-risk persons annually and expanding anti-retroviral therapy (ART) to 75% utilization) VS. Status quo

HIV high risk persons including men who have sex with men and injection drug users and low risk persons, aged 15-64 yrs in the US

21,000

Long 2010 Ann Intern Med

Screening for HIV in low-risk person once and in high-risk persons annually and expanding anti-retroviral therapy (ART) to 75% utilization VS. Expanded ART (75% utilization) only

HIV high risk persons including men who have sex with men and injection drug users and low risk persons, aged 15-64 yrs in the US

22,000

Long 2010 Ann Intern Med

Screening for HIV in low-risk person once and in high-risk persons annually VS. Status quo

HIV high risk persons including men who have sex with men and injection drug users and low risk persons, aged 15-64 yrs in the US

23,000

* Includes studies published up to May 2011

By James D. Chambers and Teja Thorat

References
1. UNAIDS. 2007 AIDS epidemic update. December 2007.  Available here
2. Centers for Disease Control and Prevention.  Available here
3. Sanders GD, et al.  Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial. J Gen Intern Med. 2010 Jun;25(6):556-63
4. Waters RC, et al. A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa. J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):443-52.

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