Cost-effectiveness analysis of integrating screening and treatment of selected non-communicable diseases into HIV/AIDS treatment in Uganda
Cost-effectiveness analysis of integrating screening and treatment of selected non-communicable diseases into HIV/AIDS treatment in Uganda
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DOI：
10.1002/jia2.25507
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发表时间：
2020-06-01
影响因子：
6
通讯作者：
Verguet, Stephane
中科院分区：
文献类型：
--
作者：
Sando, David;Kintu, Alexander;Verguet, Stephane
简介：尽管撒哈拉以南非洲地区越来越热衷于将非传染性疾病 (NCD) 治疗纳入人体免疫缺陷病毒 (HIV) 护理和治疗服务，但几乎没有证据表明这种整合可能带来健康和财务后果。我们的目标是研究乌干达环境中基本非传染性疾病-艾滋病毒整合的成本效益。方法：我们开发了一个流行病学成本模型，从提供者的角度分析在乌干达接受抗逆转录病毒治疗 (ART) 的艾滋病毒感染者 (PLWH) 整合高血压、糖尿病 (DM) 和高胆固醇筛查和治疗的成本效益。我们利用先前建立的 Globorisk 模型和系统评价中的心血管疾病 (CVD) 风险估计；来自世界卫生组织逐步监测调查方法和全球数据库的艾滋病毒和非传染性疾病危险因素患病率；成本数据来自国家药品价格表、专家咨询和文献。在随后的 10 年中，随着整合的成本效益的增加，对避免的 CVD 病例和相应的伤残调整生命年进行了估计。结果：在乌干达的 ART 患者中整合针对高血压、糖尿病和高胆固醇的服务与 CVD 事件的 10 年风险平均降低相关：老年 PLWH 妇女从 8.2% 降低到 6.6%（绝对风险降低 1.6%），从 10.7% 降低到 10.7%。老年 PLWH 男性中的风险分别降低 9.5%（绝对风险降低 1.2%）。整合预计将在老年 ART 患者中避免每残疾调整生命年产生 1,400 至 3,250 美元的净成本。结论：为乌干达 ART 患者提供高血压、糖尿病和高胆固醇服务将降低这些患者的总体 CVD 风险；它将约占国家艾滋病毒/艾滋病支出的 2.4%，其成本效益可与低收入和中等收入国家解决非传染性疾病的其他独立干预措施相媲美。
Introduction: Despite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost-effectiveness of basic NCD-HIV integration in a Ugandan setting.Methods: We developed an epidemiologic-cost model to analyze, from the provider perspective, the cost-effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization's STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability-adjusted life years were estimated over 10 subsequent years along with incremental cost-effectiveness of the integration.Results: Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10-year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability-adjusted life year averted among older ART patients.Conclusions: Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost-effectiveness comparable to other standalone interventions to address NCDs in low- and middle-income country settings.