Cost-effectiveness of point-of-care versus centralised, laboratory-based nucleic acid testing for diagnosis of HIV in infants: a systematic review of modelling studies.
Cost-effectiveness of point-of-care versus centralised, laboratory-based nucleic acid testing for diagnosis of HIV in infants: a systematic review of modelling studies.
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DOI：
10.1016/s2352-3018(23)00029-2
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发表时间：
2023-05
期刊：
影响因子：
16.1
通讯作者：
Vojnov, Lara
中科院分区：
文献类型：
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作者：
le Roux, Stanzi M.;Odayar, Jasantha;Sutcliffe, Catherine G.;Salvatore, Phillip P.;de Broucker, Gatien;Dowdy, David;McCann, Nicole C.;Frank, Simone C.;Ciaranello, Andrea L.;Myer, Landon;Vojnov, Lara
用于诊断婴儿艾滋病毒的护理点（POC）核酸检测比集中（护理标准，SOC）检测更早开始抗逆转录病毒治疗（ART），但可能更昂贵。我们通过比较POC与SOC的数学模型评估了成本效益数据，以提供全球政策指导。在这项建模研究的系统性综述中，我们检索了PubMed、MEDLINE、Embase、国家卫生服务经济评估数据库、Econlit和会议摘要，结合了“HIV”+“婴儿”/“早期婴儿诊断”+“床旁”+“成本效益”+“数学模型”等术语，从数据库成立到2022年7月15日没有限制。我们选择了比较POC与SOC用于18个月以下婴儿HIV诊断的数学成本效益模型的报告。对标题和摘要进行独立审查，对合格文章进行全文审查。我们提取了关于健康和经济结果以及增量成本效益比（ICER）的数据进行叙述性综合。关注的主要结局是HIV感染儿童ART启动和生存的ICER（比较POC与SOC）。我们通过数据库检索确定了75条记录。排除了13篇重复文献，留下62篇非重复文献。排除了57条记录，对5条进行了全文审查。1篇文章被排除，因为它不是建模研究，4项合格研究被纳入综述。这四份报告来自两个独立建模小组的两个数学模型。两份报告使用约翰霍普金斯模型比较了撒哈拉以南非洲（第一份报告，模拟25000名儿童）和赞比亚（第二份报告，模拟7500名儿童）前6个月内重复早期婴儿诊断检测的POC与SOC。在第一份报告中，在基础方案中，POC与SOC将检测后60天内开始抗逆转录病毒治疗的概率从19%增加到82%（ICER/额外的抗逆转录病毒治疗启动范围为430 -1097美元; 9个月的成本范围）;在第二份报告中，从28%增加到81%（23 -1609美元，5年的成本范围）。两份报告使用预防艾滋病并发症的成本效益-儿科模型（模拟3 000万儿童;终生水平），比较了津巴布韦6周时检测的POC与SOC。POC延长了预期寿命，与SOC相比被认为具有成本效益（ICER每年在HIV暴露儿童中挽救711 -850美元的生命）。在整个敏感性和情景分析中，结果都是稳健的。在大多数情况下，平台成本分摊来自两种不同模式的四份报告表明，与SOC相比，POC是一种具有成本效益和潜在成本节约的早期婴儿检测策略。比尔和梅林达盖茨基金会，Unitaid，国家过敏和传染病研究所，世界卫生组织国家儿童健康与人类发展研究所和马萨诸塞州总医院研究学者
Point-of-care (POC) nucleic acid testing for diagnosis of HIV in infants facilitates earlier initiation of antiretroviral therapy (ART) than with centralised (standard-of-care, SOC) testing, but can be more expensive. We evaluated cost-effectiveness data from mathematical models comparing POC with SOC to provide global policy guidance. In this systematic review of modelling studies, we searched PubMed, MEDLINE, Embase, the National Health Service Economic Evaluation Database, Econlit, and conference abstracts, combining terms for “HIV” + “infant”/”early infant diagnosis” + “point-of-care” + “cost-effectiveness” + “mathematical models”, without restrictions from database inception to July 15, 2022. We selected reports of mathematical cost-effectiveness models comparing POC with SOC for HIV diagnosis in infants younger than 18 months. Titles and abstracts were independently reviewed, with full-text review for qualifying articles. We extracted data on health and economic outcomes and incremental cost-effectiveness ratios (ICERs) for narrative synthesis. The primary outcomes of interest were ICERs (comparing POC with SOC) for ART initiation and survival of children living with HIV. Our search identified 75 records through database search. 13 duplicates were excluded, leaving 62 non-duplicate articles. 57 records were excluded and five were reviewed in full text. One article was excluded as it was not a modelling study, and four qualifying studies were included in the review. These four reports were from two mathematical models from two independent modelling groups. Two reports used the Johns Hopkins model to compare POC with SOC for repeat early infant diagnosis testing in the first 6 months in sub-Saharan Africa (first report, simulation of 25 000 children) and Zambia (second report, simulation of 7500 children). In the base scenario, POC versus SOC increased probability of ART initiation within 60 days of testing from 19% to 82% (ICER per additional ART initiation range US$430–1097; 9-month cost horizon) in the first report; and from 28% to 81% in the second ($23–1609, 5-year cost horizon). Two reports compared POC with SOC for testing at 6 weeks in Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Paediatric model (simulation of 30 million children; lifetime horizon). POC increased life expectancy and was considered cost-effective compared with SOC (ICER $711–850 per year of life saved in HIV-exposed children). Results were robust throughout sensitivity and scenario analyses. In most scenarios, platform cost-sharing (co-use with other programmes) resulted in POC being cost-saving compared with SOC. Four reports from two different models suggest that POC is a cost-effective and potentially cost-saving strategy for upscaling of early infant testing compared with SOC. Bill & Melinda Gates Foundation, Unitaid, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, WHO, and Massachusetts General Hospital Research Scholars
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影响因子：
3.7
作者：
Yee WL;Than KK;Mohamed Y;Htay H;Tin HH;Thein W;Kyaw LL;Yee WW;Aye MM;Badman SG;Vallely AJ;Luchters S;Kelly-Hanku A;AAMI study group
通讯作者：
AAMI study group
DOI：
10.1111/tmi.13627
发表时间：
2021-09
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Sutcliffe CG;Moyo N;Schue JL;Mutanga JN;Hamahuwa M;Munachoonga P;Maunga S;Thuma PE;Moss WJ
通讯作者：
Moss WJ
DOI：
10.1086/648079
发表时间：
2009-12-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Ciaranello AL;Chang Y;Margulis AV;Bernstein A;Bassett IV;Losina E;Walensky RP
通讯作者：
Walensky RP
DOI：
10.1093/cid/ciy538
发表时间：
2019-02-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Sabi I;Mahiga H;Mgaya J;Geisenberger O;Kastner S;Olomi W;Saathoff E;Njovu L;Lueer C;France J;Maboko L;Ntinginya NE;Hoelscher M;Kroidl A
通讯作者：
Kroidl A
影响因子：
2.4
作者：
通讯作者：
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