Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.
Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.
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DOI：
10.1016/s2352-3018(17)30123-6
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发表时间：
2017-10
期刊：
影响因子：
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通讯作者：
Griffiths CJ
中科院分区：
文献类型：
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作者：
Baggaley RF;Irvine MA;Leber W;Cambiano V;Figueroa J;McMullen H;Anderson J;Santos AC;Terris-Prestholt F;Miners A;Hollingsworth TD;Griffiths CJ
早期艾滋病毒诊断可降低发病率、死亡率、进一步传播的可能性及其相关费用，但由于较早开始抗逆转录病毒治疗（ART），可能会增加费用。我们通过估计初级保健中艾滋病毒筛查的成本效益来调查这种权衡。我们模拟了在伦敦（英国）哈克尼进行的RHIVA 2随机对照试验的干预组中观察到的4倍高诊断率的影响，该试验是一个HIV高患病率（成人患病率≥ 0.2%）的自治市。我们构建了一个动态的房室模型，代表感染的发生率和艾滋病毒筛查在哈克尼的一般做法的影响。我们通过将模型诊断率与试验数据拟合，必要时使用文献中的流行病学和行为数据进行参数化，使用试验检测成本和预测未来治疗成本来评估RHIVA 2试验的成本效益。在40年的时间范围内，每增加一个质量调整生命年（QALY），增量成本效益比为22201英镑（95%可信区间12662 - 132452），每避免一个死亡为372207英镑（268162 - 1903385），每避免一个艾滋病毒传播为628874英镑（434902 - 4740724）。 在此模型情景下，根据英国的成本数据，RHIVA 2将在33年后达到国家健康与护理卓越研究所的成本效益阈值上限（每获得一个QALY约3万英镑）。 使用加拿大成本数据的情景（表明晚期诊断患者的医疗保健成本延长甚至更高）表明，这一阈值可能在短短13年内达到。在初级保健中进行艾滋病毒筛查具有重要的公共卫生效益和临床效益。我们预计，从中期来看，它在英国是具有成本效益的。然而，这种干预措施可能会更快地产生成本效益，甚至节省成本，因为在高患病率地区，晚期诊断患者的长期医疗保健成本远高于早期诊断患者（≥60%）。在初级保健中进行艾滋病毒筛查具有成本效益，应予以推广。NHS城市和哈克尼，英国卫生部，国家卫生研究合作研究所在应用卫生研究和护理的领导地位。
Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662–132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162–1 903 385) per death averted, and £628 874 (434 902–4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high-prevalence regions are much higher (≥60%) than those of patients diagnosed earlier. Screening for HIV in primary care is cost-effective and should be promoted. NHS City and Hackney, UK Department of Health, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care.