Catálogo general VIH/sida
Effectiveness and cost-effectiveness of HIV screening strategies across Europe
Resumen
In the eras of both Treatment as Prevention and PrEP, HIV testing has become critical to control the epidemic. We evaluated the clinical impact, costs, and cost-effectiveness of different testing strategies for both high-risk individuals and the general population in three European countries with different epidemic profiles. We used a mathematical model of HIV disease, the Cost-Effectiveness of Preventing AIDS Complications (or 'CEPAC') Model, with country-specific clinical & economic data to project discounted life expectancy, cost and incremental cost-effectiveness ratios (ICERs) of alternative HIV screening strategies in France, Spain, and Estonia. We compared these strategies to current HIV testing practices in adults aged 18-69 in the overall population, and among Men who have Sex with Men (MSM), and People Who Inject Drugs (PWID). Input data by country included (Estonia/France/Spain): HIV prevalence (Overall: 1.3%/0.4%/0.4%; MSM: 4%/17%/6%; PWID: 55%/18%/33%), incidence per 100py (Overall: 0.03/0.02/0.01; MSM: 1.0/1.0/0.6; PWID: 6.0/0.1/1.5), mean CD4 at ART initiation (Table), current screening performance including acceptance and linkage-to-care rates; and costs for ART, HIV tests, and HIV care. We labeled a strategy 'cost-effective' if its ICER in 2015€ per year of life saved (YLS) was less than the annual per capita GDP of the country (20,000€/29,000€/24,300€). Frequent HIV testing among high-risk groups increased life expectancy in people living with HIV (PLWH) (Table). Among MSM, one test every 12 months in Estonia and France, and every 3 years in Spain, had an ICER of 16,200; 23,900; and 25,400€/ YLS. Among PWID, testing every month in Estonia, every 3 years in France, and every 6 months in Spain had ICERs of 11,000; 27,700; and 18,300€/YLS, respectively. In the general population, one additional lifetime test in France and Spain, and testing every 3 years in Estonia had ICERs of 37,100; 28,100; and 13,000€/YLS. Our findings were most sensitive to uncertainty in rates of HIV incidence, the screening frequency, and costs of HIV tests and ART. In France and Estonia, MSM should be tested every 12 months; and in Spain every 36 months. In Spain and France, PWID should be tested every 6 and 36 months, while in Estonia, the frequency could be even higher. HIV testing in the general population has also proven to be cost-effective. For optimal value, HIV screening strategies in Europe should be tailored to each country's epidemic.
Autoría:
MABILEAU, Guillaume; AMO VALERO, Julia del; RÜÜTEL, Kristi; PALTIEL, A David; LEMSALU, Liis; DÍAZ FRANCO, Asunción; FERNÁNDEZ, Jesús Martín; WALENSKY, Rochelle P.; FREEDBERG, Kenneth A.; YAZDANPANAH, Yazdan
Autoría institucional: OptTEST (Optimising testing and linkage to care for HIV across Europe)
Autoría institucional: OptTEST (Optimising testing and linkage to care for HIV across Europe)
Ficha bibliográfica
- Año de publicación:
- [2017]
- Descripción física:
- [1] p.
- Formato:
- Folleto
- Tipo de documento:
- Coloquios y ponencias
- Notas:
- Póster presentado en la CROI 2017, celebrada en Seattle (Estados Unidos) del 13 al 16 de febrero de 2017.
- Más información:
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