The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013
The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013
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DOI：
10.1093/cid/cix832
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发表时间：
2018-03-01
影响因子：
11.8
通讯作者：
Montaner, Julio S. G.
中科院分区：
文献类型：
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作者：
Nosyk, Bohdan;Min, Jeong E.;Montaner, Julio S. G.
背景资料。对抗逆转录病毒疗法(ART)二级预防益处的认识动员了全球努力，以“寻找、检测、治疗和留住”艾滋病毒携带者。我们的目标是确定2011-2013年在加拿大不列颠哥伦比亚省启动的一套艾滋病毒检测和治疗参与干预措施的成本效益。使用先前验证的动态HIV传播模型，链接的PLHIV的个人卫生管理数据和聚合水平的HIV检测数据，我们估计了初级保健检测(医院、急诊科[ED]、门诊)、ART启动和ART保留倡议与接近现状的反事实情景的成本效益。估计了艾滋病毒发病率、死亡率、费用(2015年为CDN美元)、质量调整寿命年(QALY)和增量成本效益比。分析是从政府支付者的角度进行的，时间跨度为5到25年。ED检测是最有价值的，每QALY增加30216美元，在PLHIV中对发病率和死亡率的影响最大，而ART治疗提供了最大的QALY收益。保留艺术品的倡议并不划算。在观察到的规模和整个研究期间的持续提供相结合，我们估计艾滋病毒累积发病率下降12.8%，PLHIV死亡下降4.7%，每QALY增加55258美元。结果对未确诊的PLHIV数量的不确定性最为敏感。艾滋病毒检测和ART启动干预具有成本效益，而ART保留干预不具有成本效益。制定战略，使因护理而丢失的艾滋病病毒重新投入使用，是向前推进的优先事项。
Background. Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013.Methods. Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective.Results. ED testing was the best value at $30 216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55 258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV.Conclusions. HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.