Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia
| Autor: | Owain David Williams, Jeff Gow, Charles F. Gilks, Judith Dean, Anna Crothers |
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| Rok vydání: | 2021 |
| Předmět: |
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Economic efficiency Total cost Cost-Benefit Analysis Point-of-care testing Population HIV Infections Self-testing Conventional testing Men who have sex with men Sexual and Gender Minorities 03 medical and health sciences 0302 clinical medicine Environmental health Humans Mass Screening Medicine 030212 general & internal medicine Homosexuality Male education Average cost Point of care testing education.field_of_study 030505 public health business.industry lcsh:Public aspects of medicine Health Policy Australia lcsh:RA1-1270 0807 Library and Information Studies 1110 Nursing 1117 Public Health and Health Services HIV testing Costs Test (assessment) Economic evaluation Health Policy & Services Parallel testing 0305 other medical science business Research Article |
| Zdroj: | BMC Health Services Research BMC Health Services Research, Vol 21, Iss 1, Pp 1-12 (2021) |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/s12913-020-06040-5 |
| Popis: | Background The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Methods A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. Results Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. Conclusions This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost. |
| Databáze: | OpenAIRE |
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