Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness
| Autor: | Elena Losina, Dominique Costagliola, Sylvie Deuffic-Burban, Kenneth A. Freedberg, Caroline E. Sloan, Yazdan Yazdanpanah, Stéphane Le Vu, Olivier Scemama, A. David Paltiel, Rochelle P. Walensky, Cécile Charlois-Ou, Josiane Pillonel, Caroline Semaille, Anne-Isabelle Poullié |
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| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Male
Pediatrics Public Health and Epidemiology/Screening Cost effectiveness Cost-Benefit Analysis lcsh:Medicine HIV Infections Cohort Studies 0302 clinical medicine Health care Prevalence Medicine 030212 general & internal medicine Sida lcsh:Science 0303 health sciences Multidisciplinary biology Evidence-Based Healthcare/Clinical Decision-Making Incidence 1. No poverty AIDS Serodiagnosis HIV screening Infectious Diseases/HIV Infection and AIDS Middle Aged 3. Good health Female France Research Article Infectious Diseases/Epidemiology and Control of Infectious Diseases Adult medicine.medical_specialty Adolescent Anti-HIV Agents Sensitivity and Specificity 03 medical and health sciences Humans Aged Health economics 030306 microbiology business.industry Non-Clinical Medicine/Health Economics lcsh:R AIDS serodiagnosis Hiv epidemiology biology.organism_classification Mental health Family medicine Quality of Life lcsh:Q business |
| Zdroj: | PLoS ONE PLoS ONE, Vol 5, Iss 10, p e13132 (2010) |
| ISSN: | 1932-6203 |
| Popis: | Background In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. Methods/Principal Findings We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing (“current practice”) to universal routine, voluntary HIV screening in adults aged 18–69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. “Current practice” produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. Conclusions/Significance One-time routine HIV screening in France improves survival compared to “current practice” and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable. |
| Databáze: | OpenAIRE |
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