Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities
Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities
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DOI：
10.1093/infdis/jiaa130
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发表时间：
2020-10-01
影响因子：
6.4
通讯作者：
Nosyk, Bohdan
中科院分区：
文献类型：
--
作者：
Krebs, Emanuel;Zang, Xiao;Nosyk, Bohdan
背景资料。注射毒品(PWID)者感染艾滋病毒的风险高得不成比例。我们的目标是确定在美国6个城市的PWID中降低HIV负担的最高价值的组合实施策略。使用为亚特兰大、巴尔的摩、洛杉矶、迈阿密、纽约市和西雅图校准的动态艾滋病毒传播模型，我们评估了在乐观(从最佳可用证据得出)或理想(90%覆盖率)扩大的情况下实施循证干预措施组合的价值。我们估计了PWID中艾滋病毒发病率的下降、质量调整后的寿命年(QALY)和每个城市的增量成本-效果比(ICER)(10年实施；20年；2018年美元)。最大化健康效益的组合包括6个(亚特兰大和西雅图)和12个(迈阿密)干预措施，ICER值从洛杉矶的94069美元/QALY到迈阿密的146256美元/QALY不等。这些策略将西雅图的HIV发病率降低了8.1%(可信区间为2.8%-13.2%)，在迈阿密降低了54.4%(可信区间为37.6%-73.9%)。在理想规模下，发病率下降达16.1%~75.5%。针对PWID的循证干预措施可以带来相当大的价值；然而，要结束PWID中的艾滋病毒流行，将需要创新的实施战略和支持计划，以减少护理的社会和结构性障碍。
Background. Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities.Methods. Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US).Results. Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%-13.2%) in Seattle and 54.4% (CI, 37.6%-73.9%) in Miami. Incidence reduction reached 16.1%-75.5% at ideal scale.Conclusions. Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.