LSTM Home > LSTM Research > LSTM Online Archive

Cost-per-diagnosis as a metric for monitoring cost effectiveness of HIV testing programmes in low income settings in southern Africa: health economic and modelling analysis

Downloads

Downloads per month over past year

Phillips, Andrew N, Cambiano, Valentina, Nakagawa, Fumiyo, Bansi-Matharu, Loveleen, Wilson, David, Jani, Ilesh, Apollo, Tsitsi, Sculpher, Mark, Hallett, Timothy, Kerr, Cliff, van Oosterhout, Joep J, Eaton, Jeffrey W, Estill, Janne, Williams, Brian, Doi, Naoko, Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422, Keiser, Olivia, Ford, Deborah, Hatzold, Karin, Barnabas, Ruanne, Ayles, Helen, Meyer-Rath, Gesine, Nelson, Lisa, Johnson, Cheryl, Baggaley, Rachel, Fakoya, Ade, Jahn, Andreas and Revill, Paul (2019) 'Cost-per-diagnosis as a metric for monitoring cost effectiveness of HIV testing programmes in low income settings in southern Africa: health economic and modelling analysis'. Journal of the International AIDS Society, Vol 22, Issue 7, e25325.

[img] Text
testing ms - 17 may 2019 - clean.docx - Accepted Version
Available under License Creative Commons Attribution.

Download (68kB)
[img]
Preview
Text
figure 1 - 13 march 2019.pdf - Supplemental Material
Available under License Creative Commons Attribution.

Download (393kB) | Preview
[img]
Preview
Text
figure 2 - 13 march 2019.pdf - Supplemental Material
Available under License Creative Commons Attribution.

Download (390kB) | Preview
[img]
Preview
Text
figure 3 - 14 may 2019.pdf - Supplemental Material
Available under License Creative Commons Attribution.

Download (223kB) | Preview

Abstract

Introduction: As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric.
Methods: We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of “core” testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) “core” testing as above plus “additional-testing”, for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. Discount rate 3%; costs in 2018 $US.
Results: There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost effective up to a cost-per-diagnosis of $585. The threshold cost for testing in men fell to $256 when the cost effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum.
Conclusions: For testing programmes in low income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost per DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost effectiveness of testing programmes.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1002/jia2.25325
Depositing User: Stacy Murtagh
Date Deposited: 16 Jul 2019 10:25
Last Modified: 22 Jul 2019 09:21
URI: https://archive.lstmed.ac.uk/id/eprint/10978

Statistics

View details

Actions (login required)

Edit Item Edit Item