Cost-Effectiveness of Strategies to Improve HIV Testing and Receipt of Results: Economic Analysis of a Randomized Controlled Trial
Cost-Effectiveness of Strategies to Improve HIV Testing and Receipt of Results: Economic Analysis of a Randomized Controlled Trial
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DOI：
10.1007/s11606-010-1265-5
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发表时间：
2010-06-01
影响因子：
5.7
通讯作者：
Owens, Douglas K.
中科院分区：
文献类型：
--
作者：
Sanders, Gillian D.;Anaya, Henry D.;Owens, Douglas K.
CDC建议对所有13-64岁的患者进行常规自愿HIV检测。尽管有这一建议，艾滋病毒检测率很低，即使在那些可识别的风险，许多病人不返回接收他们的结果。为了检查的成本和效益的战略，以改善艾滋病毒检测和接收结果。成本效益分析的基础上马尔可夫模型。HIV咨询和检测的三种干预模式的比较：模式A =传统的HIV咨询和检测;模式B =护士发起的常规筛查与传统的HIV检测和咨询;模式B =护士发起的常规筛查与传统的HIV检测和咨询;模式C =护士发起的常规筛查与传统的HIV检测和咨询。模型C =护士发起的常规筛查，快速HIV检测和简化咨询。生命年、质量调整生命年（QHMs）、成本和增量成本效益。不考虑减少HIV传播的好处，模型A导致每位患者终身折扣成本为48，650美元，收益为16.271 QHMs。模型B增加了53美元的生命周期成本和0.0013个季度的收益（相当于0.48个质量调整生命日）。模型C的成本比模型A高66美元，增加了0.0018个QALY（0.66个质量调整生命日），增量成本效益为36，390美元/QALY。当我们将减少艾滋病毒传播的好处包括在内时，模型C相对于模型A的成本为10，660美元/QALY。在初级保健人群中，护士发起的常规筛查与快速艾滋病毒检测和简化的咨询增加了检测率和检测结果的接收，与传统的艾滋病毒检测策略相比，具有成本效益。
The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results.To examine the costs and benefits of strategies to improve HIV testing and receipt of results.Cost-effectiveness analysis based on a Markov model. Acceptance of testing, return rates, and related costs were derived from a randomized trial of 251 patients; long-term costs and health outcomes were derived from the literature.Primary-care patients with unknown HIV status.Comparison of three intervention models for HIV counseling and testing: Model A = traditional HIV counseling and testing; Model B = nurse-initiated routine screening with traditional HIV testing and counseling; Model C = nurse-initiated routine screening with rapid HIV testing and streamlined counseling.Life-years, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness.Without consideration of the benefit from reduced HIV transmission, Model A resulted in per-patient lifetime discounted costs of $48,650 and benefits of 16.271 QALYs. Model B increased lifetime costs by $53 and benefits by 0.0013 QALYs (corresponding to 0.48 quality-adjusted life days). Model C cost $66 more than Model A with an increase of 0.0018 QALYs (0.66 quality-adjusted life days) and an incremental cost-effectiveness of $36,390/QALY. When we included the benefit from reduced HIV transmission, Model C cost $10,660/QALY relative to Model A. The cost-effectiveness of Model C was robust in sensitivity analyses.In a primary-care population, nurse-initiated routine screening with rapid HIV testing and streamlined counseling increased rates of testing and receipt of test results and was cost-effective compared with traditional HIV testing strategies.