Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial.
Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial.
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DOI：
10.1016/s2214-109x(21)00034-6
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
HPTN 071 (PopART) study team
中科院分区：
文献类型：
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作者：
Thomas R;Probert WJM;Sauter R;Mwenge L;Singh S;Kanema S;Vanqa N;Harper A;Burger R;Cori A;Pickles M;Bell-Mandla N;Yang B;Bwalya J;Phiri M;Shanaube K;Floyd S;Donnell D;Bock P;Ayles H;Fidler S;Hayes RJ;Fraser C;Hauck K;HPTN 071 (PopART) study team
HPTN 071（PopART）试验表明，与标准治疗相比，包括普遍艾滋病毒检测和治疗（UTT）在内的艾滋病毒预防组合方案降低了艾滋病毒的人群发病率。然而，关于这种干预的成本和成本效益的证据很少。使用基于个体的模型，我们模拟了PopART干预和标准治疗，根据赞比亚和南非21个试验社区的国家指南（针对所有年龄>14岁的个体）提供抗逆转录病毒治疗（ART），并在PopART试验期间和从公开来源收集模型参数和主要成本数据。模拟了两种干预方案：2014年至2030年的年度PopART（PopART 2014-30;作为UNAIDS快速通道目标年）和整个试验干预期间的三轮PopART（PopART 2014-17）。对于每个国家，我们计算了增量成本效益比（ICER），即每残疾调整生命年（DALY）的成本和避免艾滋病毒感染的成本。成本-效果可接受性曲线用于表明PopART与标准治疗相比在避免的每个DALY的不同成本阈值下具有成本效益的概率。我们还通过预测干预措施的未贴现成本与2030年标准护理相比评估了预算影响。2014- 2017年期间，通过社区艾滋病毒护理提供者为模拟人群提供基于家庭的艾滋病毒咨询和检测、与护理联系、促进ART依从性和自愿医疗男性包皮环切术的人均年平均成本在赞比亚为6.53美元（SD 0.29），在南非为7.93美元（SD 0.16）。在PopART 2014-30情景中，PopART在2030年之前每年提供的ICER中位数为2111美元（95%可信区间[CrI] 1827-2462）和3248美元（2472-3963）美元;赞比亚和南非分别为593美元（95%CrI 526-674）和645美元（538-757）。在PopART 2014-17情景中，PopART在赞比亚以1318美元（1098-1591）的成本避免了一次感染，在南非以2236美元（1601-2916）的成本避免了一次感染，在赞比亚以258美元（225-298）的成本避免了一次DALY，在南非以326美元（266-391）的成本避免了一次DALY。在PopART 2014-30情景中，在赞比亚避免的每DALY阈值超过700美元，在南非避免的每DALY阈值超过800美元时，干预措施具有成本效益的概率几乎为100%。到2030年，赞比亚和南非每年各轮的递增方案成本分别为4 612万美元（平均341 323人）和3 024万美元（平均165 852人）。 结合预防与普遍的家庭为基础的测试可以提供低人均年成本，但积累到相当大的数额时，规模不断增长的人口。包括UTT在内的综合预防在避免的每DALY超过800美元的阈值时具有成本效益，可以成为在高流行率环境中降低艾滋病毒发病率的有效战略。美国国立卫生研究院，总统艾滋病紧急救援计划，国际影响评估倡议，比尔和梅林达盖茨基金会。
The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention. Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged >14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014–30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014–17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030. During 2014–17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014–30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827–2462) per HIV infection averted in Zambia and $3248 (2472–3963) per HIV infection averted in South Africa; and $593 (95% CrI 526–674) per DALY averted in Zambia and $645 (538–757) per DALY averted in South Africa. In the PopART 2014–17 scenario, PopART averted one infection at a cost of $1318 (1098–1591) in Zambia and $2236 (1601–2916) in South Africa, and averted one DALY at $258 (225–298) in Zambia and $326 (266–391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014–30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa. Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings. US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation.
影响因子：
3.7
作者：
Tchuenche M;Palmer E;Haté V;Thambinayagam A;Loykissoonlal D;Njeuhmeli E;Forsythe S
通讯作者：
Forsythe S