Cost-effectiveness of HIV counseling and testing in US prisons
Cost-effectiveness of HIV counseling and testing in US prisons
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DOI：
10.1093/jurban/78.2.304
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发表时间：
2001-06-01
影响因子：
6.6
通讯作者：
Peterman, TA
中科院分区：
文献类型：
--
作者：
Varghese, B;Peterman, TA
教养所中的人体免疫机能丧失病毒（艾滋病毒）流行率远远高于一般人口。然而，艾滋病毒预防资源有限，因此必须评估监狱环境中的不同预防方案。我们的研究提出了在美国监狱中为即将获释的囚犯提供艾滋病咨询和检测（CTI）的成本效益。一个决策模型被用来估计艾滋病毒检测和咨询的成本和效益（避免艾滋病毒病例）相比，没有CT从社会的角度。模型参数是艾滋病毒的患病率，否则未经测试的囚犯（1%），接受CT（50%），艾滋病毒传播的风险从感染者（7%），艾滋病毒感染的风险为未感染者（0.3%）收购;和减少后的风险咨询感染者（25%）和未感染者（20%）。每个人的检测和咨询的边际成本被用于固定成本。如果被感染，成本是78.17美元;如果未被感染，它运行24.63美元。一生的治疗费用为186，900美元，用于估计预防艾滋病毒感染的好处。进行灵敏度和阈值分析以测试这些参数的稳健性。我们的基线模型显示，与没有CT相比，为10，000名囚犯提供CT检测50个新的或以前未诊断的感染，并避免4个未来的艾滋病毒病例，监狱系统的成本为125，000美元。这将为社会节省超过55万美元。艾滋病毒流行率、传播风险或咨询有效性的增加增加了社会储蓄。随着患病率的增加，关注艾滋病毒感染的囚犯可以预防未来的感染;然而，当艾滋病毒患病率低于5%时，对感染和未感染的囚犯进行检测和咨询对艾滋病毒预防非常重要。
The prevalence of human immunodeficiency virus (HIV) in correctional facilities is much higher than in the general population. However, HIV prevention resources are limited, making it important to evaluate different prevention programs in prison settings. Our study presents the cost-effectiveness of offering HIV counseling and testing (CTI to soon-to-be-released inmates in US prisons. A decision model was used to estimate the costs and benefits (averted HIV cases) of HIV testing and counseling compared to no CT from a societal perspective. Model parameters were HIV prevalence among otherwise untested inmates (1%); acceptance of CT (50%); risk for HIV transmission from infected individuals (7%); risk of HIV acquisition for uninfected individuals (0.3%); and reduction of risk after counseling for those infected (25%) and uninfected (20%). Marginal costs of testing and counseling per person were used Ino fixed costs). If infected, the cost was $78.17; if uninfected, it runs $24.63. A lifetime treatment cost of $186,900 was used to estimate the benefits of Prevented HIV infections. Sensitivity and threshold analysis were done to test the robustness of these parameters. Our baseline model shows that, compared to no CT, offering CT to 10,000 inmates detects 50 new or previously undiagnosed infections and averts 4 future cases of HIV at a cost of $125,000 to prison systems. However, this will save society over $550,000. Increase in HIV prevalence, risk of transmission, or effectiveness of counseling increased societal savings. As prevalence increases, focusing on HIV-infected inmates prevents additional future infections; however, when HIV prevalence is less than 5%, testing and counseling of both infected and uninfected inmates are important for HIV prevention.