Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Martin Hoenigl, Joshua Graff-Zivin and Susan J Little
Authors registered in the RePEc Author Service: Joshua Graff Zivin

University of California at San Diego, Economics Working Paper Series from Department of Economics, UC San Diego

Abstract: Background In nonhealthcare settings, widespread screening for acute human immunodeficiency virus (HIV) infection (AHI) is limited by cost and decision algorithms to better prioritize use of resources. Comparative cost analyses for available strategies are lacking. Methods To determine cost-effectiveness of community-based testing strategies, we evaluated annual costs of 3 algorithms that detect AHI based on HIV nucleic acid amplification testing (EarlyTest algorithm) or on HIV p24 antigen (Ag) detection via Architect (Architect algorithm) or Determine (Determine algorithm) as well as 1 algorithm that relies on HIV antibody testing alone (Antibody algorithm). The cost model used data on men who have sex with men (MSM) undergoing community-based AHI screening in San Diego, California. Incremental cost-effectiveness ratios (ICERs) per diagnosis of AHI were calculated for programs with HIV prevalence rates between 0.1% and 2.9%. Results Among MSM in San Diego, EarlyTest was cost-savings (ie, ICERs per AHI diagnosis less than $13.000) when compared with the 3 other algorithms. Cost analyses relative to regional HIV prevalence showed that EarlyTest was cost-effective (ie, ICERs less than $69.547) for similar populations of MSM with an HIV prevalence rate >0.4%; Architect was the second best alternative for HIV prevalence rates >0.6%. Conclusions Identification of AHI by the dual EarlyTest screening algorithm is likely to be cost-effective not only among at-risk MSM in San Diego but also among similar populations of MSM with HIV prevalence rates >0.4%.

Keywords: Biomedical and Clinical Sciences; Clinical Sciences; Comparative Effectiveness Research; Sexually Transmitted Infections; Prevention; Bioengineering; Clinical Research; Sexual and Gender Minorities (SGM/LGBT*); Health Services; HIV/AIDS; Infectious Diseases; Cost Effectiveness Research; 4.4 Population screening; 8.2 Health and welfare economics; Infection; Good Health and Well Being; Algorithms; California; Cohort Studies; Costs and Cost Analysis; Early Diagnosis; HIV; HIV Infections; Homosexuality; Male; Humans; Immunoassay; Male; Mass Screening; Molecular Diagnostic Techniques; acute HIV; MSM; testing; cost analysis; NAT; Biological Sciences; Medical and Health Sciences; Microbiology; Clinical sciences (search for similar items in EconPapers)
Date: 2016-02-15
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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