Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness

Yazdan Yazdanpanah, Julian Perelman, Madeline A DiLorenzo, Joana Alves, Henrique Barros, Ceu Mateus, João Pereira, Kamal Mansinho, Marion Robine, Ji-Eun Park, Eric L Ross, Elena Losina, Rochelle P Walensky, Farzad Noubary, Kenneth A Freedberg and A David Paltiel

PLOS ONE, 2013, vol. 8, issue 12, 1-

Abstract: Objective: To compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening. Design: We used Portuguese national clinical and economic data to conduct a model-based assessment. Methods: We compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/μL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost €6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness. Results: One-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of €28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of €21,000/QALY and €34,000/QALY, respectively. Conclusions: One-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal’s challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.

Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0084173

DOI: 10.1371/journal.pone.0084173

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