Expanded screening for HIV in the United States - An analysis of cost-effectiveness
Expanded screening for HIV in the United States - An analysis of cost-effectiveness
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DOI：
10.1056/nejmsa042088
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发表时间：
2005-02-10
影响因子：
158.5
通讯作者：
Walensky, RP
中科院分区：
文献类型：
--
作者：
Paltiel, AD;Weinstein, MC;Walensky, RP
背景：尽管疾病控制和预防中心（CDC）建议在至少1%的HIV流行率的环境中进行常规HIV咨询，检测和转诊（HIVCTR），但大约有280，000名美国人不知道他们的人类免疫缺陷病毒（HIV）感染。在有效的抗逆转录病毒治疗的时代，扩大艾滋病毒筛查的效果是未知的。方法：我们开发了一个艾滋病毒筛查和治疗的计算机模拟模型，以比较常规，自愿HIVCTR与三个目标人群的现行做法：“高危”（未确诊的艾滋病毒感染率为3.0%;年发病率为1.2%）;"疾病预防控制中心阈值“（分别为1.0%和0.12%）;和“美国将军”（0.1%和0.01%）。输入数据来自临床试验和观察性队列。结果包括质量调整后的生存率，成本和成本效益。结果：在高危人群中，除了一次性筛查HIV抗体与酶联免疫吸附试验（ELISA），目前的做法与早期诊断HIV（平均CD 4细胞计数诊断，210与154每立方毫米）。一次性筛查也提高了艾滋病毒感染者的平均生存时间（质量调整生存期，220.7个月对219.8个月）。每获得一个质量调整生命年，增量成本效益为36，000美元。每五年进行一次测试，每获得一个质量调整生命年的成本为50，000美元，每三年进行一次测试，每获得一个质量调整生命年的成本为63，000美元。在CDC临界人群中，ELISA一次性筛查的成本效益比为每获得质量调整生命年38，000美元，而每五年检测一次的成本为每获得质量调整生命年71，000美元，每三年检测一次的成本为每获得质量调整生命年85，000美元。在美国一般人群中，一次性筛查费用$113，000每质量调整生命yeargained.CONCLUSIONS：在所有但风险最低的人群，常规，自愿筛查艾滋病毒每三至五年一次是合理的临床和成本效益的理由。在一般人群中进行一次性筛查也可能具有成本效益。
BACKGROUND:Although the Centers for Disease Control and Prevention (CDC) recommend routine HIV counseling, testing, and referral (HIVCTR) in settings with at least a 1 percent prevalence of HIV, roughly 280,000 Americans are unaware of their human immunodeficiency virus (HIV) infection. The effect of expanded screening for HIV is unknown in the era of effective antiretroviral therapy.METHODS:We developed a computer simulation model of HIV screening and treatment to compare routine, voluntary HIVCTR with current practice in three target populations: ``high-risk'' (3.0 percent prevalence of undiagnosed HIV infection; 1.2 percent annual incidence); ``CDC threshold'' (1.0 percent and 0.12 percent, respectively); and ``U.S. general'' (0.1 percent and 0.01 percent). Input data were derived from clinical trials and observational cohorts. Outcomes included quality-adjusted survival, cost, and cost-effectiveness.RESULTS:In the high-risk population, the addition of one-time screening for HIV antibodies with an enzyme-linked immunosorbent assay (ELISA) to current practice was associated with earlier diagnosis of HIV (mean CD4 cell count at diagnosis, 210 vs. 154 per cubic millimeter). One-time screening also improved average survival time among HIV-infected patients (quality-adjusted survival, 220.7 months vs. 219.8 months). The incremental cost-effectiveness was $36,000 per quality-adjusted life-year gained. Testing every five years cost $50,000 per quality-adjusted life-year gained, and testing every three years cost $63,000 per quality-adjusted life-year gained. In the CDC threshold population, the cost-effectiveness ratio for one-time screening with ELISA was $38,000 per quality-adjusted life-year gained, whereas testing every five years cost $71,000 per quality-adjusted life-year gained, and testing every three years cost $85,000 per quality-adjusted life-year gained. In the U.S. general population, one-time screening cost $113,000 per quality-adjusted life-year gained.CONCLUSIONS:In all but the lowest-risk populations, routine, voluntary screening for HIV once every three to five years is justified on both clinical and cost-effectiveness grounds. One-time screening in the general population may also be cost-effective.