Strengthening Existing Laboratory-Based Systems vs. Investing in Point-of-Care Assays for Early Infant Diagnosis of HIV: A Model-Based Cost-Effectiveness Analysis
| Autor: | Nicole C McCann, Kenneth A. Freedberg, Jennifer Cohn, Emma Sacks, Oluwarantimi Adetunji, Collins Odhiambo, Christopher Panella, Clare Flanagan, Andrea L. Ciaranello, Haurovi Mafaune, Rochelle P. Walensky, Addmore Chadambuka, Sushant Mukherjee, Kenneth K Maeka |
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| Rok vydání: | 2020 |
| Předmět: |
Zimbabwe
Total cost Cost-Benefit Analysis Art initiation Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Sensitivity and Specificity HIV Testing Return time early infant diagnosis medicine Humans Pharmacology (medical) cost-effectiveness Sensitivity analyses Point of care business.industry nucleic acid test Infant Newborn HIV Infant Health Care Costs Cost-effectiveness analysis Kenya Antiretroviral therapy Early Diagnosis Models Economic Infectious Diseases point-of-care Point-of-Care Testing ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Supplement Article business Demography |
| Zdroj: | Journal of Acquired Immune Deficiency Syndromes (1999) |
| ISSN: | 1525-4135 |
| Popis: | Supplemental Digital Content is Available in the Text. Background: To improve early infant HIV diagnosis (EID) programs, options include replacing laboratory-based tests with point-of-care (POC) assays or investing in strengthened systems for sample transport and result return. Setting: We used the CEPAC-Pediatric model to examine clinical benefits and costs of 3 EID strategies in Zimbabwe for infants 6 weeks of age. Methods: We examined (1) laboratory-based EID (LAB), (2) strengthened laboratory-based EID (S-LAB), and (3) POC EID (POC). LAB/S-LAB and POC assays differed in sensitivity (LAB/S-LAB 100%, POC 96.9%) and specificity (LAB/S-LAB 99.6%, POC 99.9%). LAB/S-LAB/POC algorithms also differed in: probability of result return (79%/91%/98%), time until result return (61/53/1 days), probability of initiating antiretroviral therapy (ART) after positive result (52%/71%/86%), and total cost/test ($18.10/$30.47/$30.71). We projected life expectancy (LE) and average lifetime per-person cost for all HIV-exposed infants. We calculated incremental cost-effectiveness ratios (ICERs) from discounted (3%/year) LE and costs in $/year-of-life saved (YLS), defining cost effective as an ICER |
| Databáze: | OpenAIRE |
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