The cost-effectiveness of expanded testing for primary HIV infection
The cost-effectiveness of expanded testing for primary HIV infection
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DOI：
10.1370/afm.375
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发表时间：
2005-09-01
影响因子：
4.4
通讯作者：
Coco, A
中科院分区：
文献类型：
--
作者：
Coco, A
目的人类免疫缺陷病毒（humanimmunodeficiencyvirus，HIV）的原发性感染是HIV流行的主要因素。大多数患者出现症状并寻求护理，但很少进行测试或诊断他们的病情。本研究的目的是确定是否具有成本效益的扩大测试原发性艾滋病毒感染的一个更大的队列的patients. METHODS，如果是这样，其中诊断检测是最具成本效益的，我们进行了一个成本效益分析测试一个假设的队列超过300万门诊患者发热和其他病毒症状，而不管艾滋病毒的危险因素，使用3个诊断检测：p24抗原酶免疫吸附试验（EIA）、HIV-1 RNA试验和第三代HIV-1 EIA。当CD 4细胞计数降至350/μ L时，开始抗逆转录病毒治疗。结果的措施是增量成本效益的诊断检测，确定的病例数，避免在性伴侣的情况下，和阈值患病率。对于敏感性分析，我们使用$50，000作为阈值为cost-effectiveness.RESULTS在基线患病率为0.66%，p24抗原EIA检测是最具成本效益的选择，成本为$30，800每质量调整后的生命年获得相比，没有测试。确认了17 054例病例，435名伴侣避免了感染。概率敏感性分析，其中所有变量的估计值同时变化，确定扩大检测p24抗原EIA与不检测相比，在基线流行率下具有67%的成本效益概率，在流行率为1%时具有71%的概率。结论扩大检测p24抗原EIA对原发性HIV感染可能是一种合理的卫生保健资源支出。
PURPOSE Primary infection with the human immunodeficiency virus (HIV) is a major factor in the HIV epidemic. Most patients become symptomatic and seek care, but seldom are they tested or is their condition diagnosed. The objectives of this study are to determine whether it is cost-effective to expand testing for primary HIV infection to a larger cohort of patients, and, if so, which diagnostic assay is most cost-effective.METHODS We undertook a cost-effectiveness analysis of testing a hypothetical cohort of more than 3 million outpatients with fever and other viral symptoms regardless of HIV risk factors using 3 diagnostic assays: p24 antigen enzyme immunosorbent assay (EIA), HIV-1 RNA assay, and third-generation HIV-1 EIA. Antiretroviral therapy was started when the CD4 cell count decreased to 350/mu L. Outcome measures were the incremental cost-effectiveness of the diagnostic assays, number of cases identified, cases avoided in sexual partners, and threshold prevalence. For sensitivity analyses, we used $50,000 as the threshold for cost-effectiveness.RESULTS At the baseline prevalence of 0.66%, p24 antigen EIA testing was the most cost-effective option at a cost of $30,800 per quality-adjusted life-year gained when compared with no testing. There were 17,054 cases identified, and infection was avoided in 435 partners. Probabilistic sensitivity analysis, in which the estimates for all variables are varied simultaneously, determined that expanded testing with p24 antigen EIA compared with no testing had a 67% probability of being cost-effective at the baseline prevalence and a 71% probability at a prevalence of 1%.CONCLUSIONS Expanded testing for primary HIV infection with p24 antigen EIA may be a sound expenditure of health care resources.